Real Time Three‐Dimensional Echocardiography for Evaluation of Congenital Heart Defects: State of the Art

Abstract

Real time three-dimensional echocardiography (RT3DE) has been increasingly used in the diagnosis and assessment of congenital heart disease. A growing body of literature suggests that this new technology can be used as an integrated approach to assess the morphology of simple and complex congenital heart defects, flow abnormality, and left, right, and single ventricular function both qualitatively and quantitatively. This review summarizes the available evidence for the use of RT3DE in each of these areas. Future technology refinement in RT3DE and development of practice guidelines will increase the utilization of this new technology as a valuable tool to compliment 2D echocardiography/Doppler in clinical care and research to improve the care and outcome of congenital heart disease.

Real Time Three‐Dimensional Echocardiography for Quantification of Ventricular Volumes, Mass, and Function in Children with Congenital and Acquired Heart Diseases

“…Future advancements in hardware are expected to allow acquisition of wide‐angle 3D data from the entire heart in a single cardiac cycle, with higher spatial and temporal resolution. We anticipate that further development in automatic quantitative analysis algorithms and software will make RT3DE an integral clinical methodology for diagnosis, prognosis, and assessment of medical, percutaneous, and surgical intervention for congenital heart disease …”

The Incremental Value of Three‐Dimensional Transthoracic Echocardiography in Adult Congenital Heart Disease

“…In patients with ostium secundum ASD's (the most common type of ASD), which occur in the region of the fossa ovalis, 3D TTE can properly visualize the defect and its surrounding margins especially the anterior and inferior rims, which are specifically important when considering percutaneous closure. 13,16 The measurements provided by 3D TTE and the identification of the appropriate margins of a defect are closely comparable to those made by 3D TEE during intraoperative surgical repair and balloon sizing during percutaneous repair. 13 When an inappropriately sized occluder device is used, complications such as embolization of the device can occur, requiring further surgical intervention.…”

“…A clear anatomic image of the defect provides crucial information when deciding which therapeutic intervention to proceed with, favoring 3D TTE over 2D echocardiography. In patients with ostium secundum ASD's (the most common type of ASD), which occur in the region of the fossa ovalis, 3D TTE can properly visualize the defect and its surrounding margins especially the anterior and inferior rims, which are specifically important when considering percutaneous closure . The measurements provided by 3D TTE and the identification of the appropriate margins of a defect are closely comparable to those made by 3D TEE during intraoperative surgical repair and balloon sizing during percutaneous repair .…”

“…Real time 3D TTE is useful in identifying the location, size, and shape of the VSD (Fig. ) . The size of the VSD can be better understood by 3D TTE compared with 2D TTE because of the improved visualization of the major and minor axes of the defect .…”

“…16 The size of the VSD can be better understood by 3D TTE compared with 2D TTE because of the improved visualization of the major and minor axes of the defect. 16 By sectioning the 3D datasets, an en face view of the defect can be obtained by 3D TTE to make more accurate measurements of the area and circumference which helps in planning for appropriate treatments. Similar to case of ASDs, surgery has been the gold standard for treatment of VSDs for many years, but now, there is a move toward the use of percutaneous closure of VSDs, when feasible, because of the reduced rate of mortality and complications compared with surgery.…”