Left ventricular ejection fraction in children measured by three-dimensional echocardiography using a new transthoracic integrated 3D-probe A comparison with equilibrium radionuclide angiography

Abstract

Background Three-dimensional echocardiography allows calculation of left ventricular ejection fraction without geometric assumption on the ventricular shape. Our aim was to validate this technique in a paediatric population with distorted ventricles.Methods Twenty-one patients aged 6 months to 17 years underwent equilibrium radionuclide angiography and three-dimensional echocardiography. Fourteen patients had dilated cardiomyopathy and seven had univentricular hearts. A new, easy to handle, transthoracic rotational probe was used and motion artefacts were limited during the rotation (3 intervals with ECG and respiratory gating). Left ventricular volumes and ejection fraction were calculated using the Simpson's rule with 12 slices.Results Three-dimensional echocardiography correlated well with equilibrium radionuclide angiography for ejection fraction measurement (r=0·90; the mean difference between the two methods being 3·8 6%). Intra-observer and interobserver variabilities for 3D echocardiography were 2·4% and 4·5%.Conclusions Three-dimensional echocardiography is an accurate, non-invasive, and reproducible methods to measure left ventricular ejection fraction in children.

Influence of atrial septal defect anatomy in patient selection and assessment of closure with the Cardioseal device. A three-dimensional transoesophageal echocardiographic reconstruction

“…It gives a stretched diameter but our study clearly showed a very poor correlation between the stretched diameter and the threedimensional echocardiography maximal diameter, particularly in atrial septal defects of complex shapes: balloon measurement overestimates the size of round defects by stretching the septum tissue and underestimates the size of multiple defects by measuring only one hole. Furthermore, two-dimensional transoesophageal echocardiography is currently used to assess the (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23) 2DE=rim surrounding the atrial septal defect obtained by two-dimensional transoesophageal echocardiography; 3DE=measurements obtained by three-dimensional echocardiography; Mean diff=mean difference between the two methods; AS=antero-superior rim; PS=postero-superior rim; AI=antero-inferior rim; PI=postero-inferior rim.…”

“…Further improvement to decrease the time of three-dimensional reconstruction and measurement is required for easier clinical application. The ability of three-dimensional reconstruction direct from the digital images without transformation into video signals would also improve the quality of the three-dimensional images, which is still very dependent on the gain settings [19,20] . It is too soon to conside three-dimensional echocardiography as the reference for atrial septal defect diameter and rim measurement.…”

Hemodynamic improvement is faster after percutaneous ASD closure than after surgery

“…Three-dimensional (3D) echocardiography is a new, noninvasive method to assess LV diastolic and systolic function; its major advantage being its independence of LV geometry [10,11]. Its results correlate closely with those of cardiac catheterization [12], radionuclide angiography [13], and magnetic resonance imaging [14,15].…”

Three-Dimensional Echo: Transition from Theory to Real-Time, A Technology Now Ready for Prime Time

“…For example, Acar and coworkers studied 21 pediatric patients with distorted ventricles (14 with dilated cardiomyopathy, 7 with univentricular hearts palliated by Fontan-type procedures) comparing TTE rotational 3DE to radionuclide angiography with relatively close correlation (r ϭ 0.90). 49 In contrast, Papavassiliou and coworkers studied RV volumes in 13 patients with congenital heart disease and found correlation of EF measurements with MRI to be somewhat lacking (r ϭ 0.64) despite close correlation between end-systolic and end-diastolic volume measurements (r ϭ 0.91 and 0.90, respectively). 45 The limited data available comparing TTE rotational 3DE to standard 2D TTE arise from populations with abnormally shaped hearts for whom geometric assumptions might predictably be of greater importance.…”

“…Rotational scanning techniques have also been widely used to assess LV volumes, ejection fraction, and mass. [41][42][43][44][45][46][47][48][49] When applied to TEE, this technique has yielded surprising accuracy. Kuhl, for example, determined in vitro left ventricular mass by using a multiplane transesophageal transducer and found stronger correlations and agreement with anatomic values than were determined by 2DE (r ϭ 0.98, SEE ϭ 9.6 g versus r ϭ 0.72, SEE ϭ 42.8 g).…”