The Ability of Live Three-Dimensional Transesophageal Echocardiography to Evaluate the Attachment Site of Intracardiac Tumors

Abstract

In this study, a case of a right ventricular myxoma and a case of a right ventricular hemangioma are used to demonstrate the ability of live three-dimensional transesophageal echocardiography (3DTEE) to assess the site of tumor attachment. Because 3DTEE has the ability to visualize desired structures in multiple planes, we defined the attached portion of the tumors and measured the en face view dimensions. In addition, the improved ability of 3DTEE to evaluate tissue characteristics allowed differentiation of the heterogeneous myxoma and highly vascular hemangioma. On the contrary, because two-dimensional (2D) TEE only allows structures to be viewed in a 2D plane, the attachment site can be located but complete delineation and measurement of area is not possible. As surgical options become less invasive, accurate attachment site location and size will become more important to ensure complete excision.

Cardiac tumors and sources of embolism

“…They vary in size between less than 1 cm and more than 8 cm and are pedunculated, noncalcified but hyperdense [42]. Recent reports have shown the additive value of RT3DE in the detection and characterization of hemangioma, for example, RT3DE detects more extensive and closely packed echolucencies [36] and an intensive vascularization compared to myxoma [37].…”

“…Usually connected to the endocardium by a pedicle, myxoma can also occur with a broad base. RT3DE has been demonstrated to provide accurate anatomic visualization as well as improved identification of the spatial relation of a myxoma to the interatrial septum [35][36] [37]. Butz et al [35] described an improvement in evaluation of obstructive effects on ventricular in-or outflow by using RT3D TEE.…”

Incremental benefit of three‐dimensional transesophageal echocardiography in the assessment of a primary pericardial hemangioma

“…Initial cropping of the 3D datasets in an anteroposterior direction demonstrated a heterogenous pattern similar to 2DTTE and 2DTEE but cropping of the anterior and mid portions of the mass revealed multiple closely packed echolucent areas that extended all the way to the periphery. These findings which were not seen on 2DTTE or 2DTEE in this patient have been previously described by 3D echocardiography as characteristic of cardiac hemangiomas . These represent vascular channels which are located throughout the tumor including the peripheral region.…”

Primary Intimal (Spindle Cell) Sarcoma of the Left Atrium

“…Although echocardiography is very sensitive in predicting the etiology of most intracavitary cardiac masses, it is less reliable in determining the nature of intramural or extra myocardial lesions. However, three‐dimensional echocardiography is very sensitive in determining the presence, site, and nature of a cardiac mass . The mass and its anatomical relationship with surrounding tissue could be visualized clearly by preoperative three‐dimensional image, and operation can be done under three‐dimensional TEE guidance …”

“…However, three-dimensional echocardiography is very sensitive in determining the presence, site, and nature of a cardiac mass. 5,6 The mass and its anatomical relationship with surrounding tissue could be visualized clearly by preoperative three-dimensional image, and operation can be done under three-dimensional TEE guidance. 7 The prognosis of cardiac primary intimal (spindle cell) sarcomas is generally poor.…”