Evolving Role of Three-Dimensional Echocardiography in the Cardiac Surgical Patient

Abstract

The first human three-dimensional transesophageal echocardiography (3D TEE) was reported in 1992. Ever since, technologic advances have revolutionized this echocardiographic imaging modality. Today, real-time 3D TEE (RT-3D TEE) represents a novel clinical and intuitively educational perioperative cardiovascular imaging tool. In addition, live 3D TEE adds significantly to the perioperative communication between cardiac surgeons and echocardiographer. Its unique ability of real-time acquisition and accurate identification of precise cardiac pathology, together with its ability to promptly quantify 3D datasets using builtin software, has greatly helped to transition 3D TEE into the standard of perioperative care. The recent development of percutaneous procedures such as valve implantations and repairs also benefit from 3D TEE quantification and guidance. This article reviews the available 3D TEE acquisition modes, newest advances in 3D technology, and the utility of 3D TEE in different settings of cardiac procedures.

The Use of Intraoperative Three-Dimensional Echocardiography to Evaluate Origin of Bioprosthetic Aortic Valve Regurgitant Jets

“…Meanwhile, live, narrow sector, single-beat colored 3D imaging provides additional depth of field compared with 2D images, allowing for more accurate visualization of annular structures, such as the aortic valve, and greater appreciation for subtle findings that might be missed in a single 2D cutting plane. 6 Although this latter modality generally results in significantly lower temporal and spatial resolution when used with color flow Doppler, its functionality continues to improve with each new generation of echocardiography machines. 7…”

Intraoperative Transesophageal Echocardiography: Review and Evolution

“…The accuracy of LV volumes and function attained by TEE assemble those acquired by cardiac magnetic resonance image (cMRI). As technology continues to grow, LV volumes and ejection fraction became easy and quick values analysed during surgery and early detection of wall motion abnormalities, helped evaluating patient cardiac function status intraoperatively [1,8].…”

“…During cardiac surgery, LV mass can be calculated by multiplying the LV myocardium volume by its weight through iTEE, permitting diagnose LV pathology, such hypertrophic cardiomyopathy [8]. This is remarkably useful in non-elective surgeries where cardiac abnormalities are found.…”

“…3D technology permits complete assessment of RV volumes, anatomy, geometry and ejection fraction. With this capability, it is expected that RV imaging and function become part of a comprehensive TEE examination, emphasizing the influence of this evaluation [8,9]. Although, iTEE is not the gold standard for pulmonary embolism (PE), echocardiographic findings consistent with acute PE are RV dysfunction an atypical wall motion abnormalities of RV free wall [1].…”

“…In addition, color Doppler 3D TEE can show the right location of paravalvular MR, helpful for transcatheter closure of leaks with immediate surgical correction. It is necessary to exclude mitral stenosis, and assess ventricular function [8,9,18,19,[21][22][23][24][25]. Even some echocardiographic variables are recently identified as independent risk predictors of procedural failure [26].…”