Three-dimensional echocardiography using a transoesophageal imaging probe: Potentials and technical considerations

Abstract

Appreciation of three-dimensional relationships could be useful in cardiac diagnosis, decision making and planning of surgery. However, current ultrasound techniques provide only two-dimensional views. A recently developed echocardiographic computerized tomography unit allows reconstruction of three-dimensional images from a series of transoesophageal slices. To evaluate the potentials and limitations of this technique we performed echo computer tomographic examinations in 104 patients with a total number of 227 scans. All but two patients tolerated the procedure well and no serious complications were encountered. Indications for echo computer tomography included coronary artery disease, valvular heart disease, atrial masses, myocardial infarction, mitral and aortic valve replacement, aortic aneurysm and congenital defects. Most of the anatomical structures could be visualized with the best results obtained for the left atrium, the left ventricular outflow tract and the aortic and mitral valve apparatus. However, a variety of technical factors must be considered to achieve optimal results and to avoid misinterpretation. In 86% of patients the underlying pathology could be visualised by echo-computed tomography, particularly congenital defects such as those of the atrial or ventricular septa, but mitral valve pathologies provided the best results. In these cases three-dimensional imaging led to a better perception and understanding of structural relationships. In conclusion, despite current limitations in data acquisition, processing and computing power, echo computer tomography has the potential to provide relevant information in selected clinical settings.

Real-time three-dimensional echocardiography for rheumatic mitral valve stenosis evaluation

“…To date, routine transthoracic use of three-dimensional echocardiography has not been performed due to the cumbersome nature of old methods (14,15). With the recent advent of RT3D, many of these limitations have been overcome.…”

A Comparison of Echocardiographic Modalities to Guide Structural Heart Disease Interventions

“…41 Furthermore, examination of the short-axis mitral valve area pre-and postballoon dilation demonstrates remarkable accuracy and agreement with the Gorlin-derived mitral valve area. 42,43 This finding is largely attributable to the ability of 3D echocardiography to compensate for the nonplanar orientation of the mitral valve, thereby avoiding either over-or underestimation of the valve area, which can occur when measurements are obtained off-axis (Fig. 6).…”

“…3D echocardiography has demonstrated superiority over its 2D counterpart in the evaluation of mitral stenosis with recent data revealing excellent visualization of the mitral valve, interatrial septum, and left ventricle using RT3D‐TEE 41 . Furthermore, examination of the short‐axis mitral valve area pre‐ and postballoon dilation demonstrates remarkable accuracy and agreement with the Gorlin‐derived mitral valve area 42,43 . This finding is largely attributable to the ability of 3D echocardiography to compensate for the nonplanar orientation of the mitral valve, thereby avoiding either over‐ or underestimation of the valve area, which can occur when measurements are obtained off‐axis (Fig.…”