Three Dimensional Echocardiography: Approaches and Clinical Utility

Effective performance and interpretation of two dimensional (2D) echocardiography requires one to mentally integrate the collected images into a three dimensional (3D) reconstruction of the heart. To do this accurately, one must understand the relationship of each 2D image to one another. Quantification of cardiac structure and function by 2D echocardiography typically requires assumptions about the geometry of the structure being measured so that specific formulae can be accurately used.

3D echocardiography eliminates the need for cognitive reconstruction of image planes and use of geometric assumptions about shape of structures for cardiac quantitation. This particularly applies to complex shapes such as the right ventricle, an aneurysmal left ventricle (LV), an asymmetrically stenotic or regurgitant valve orifice, eccentric regurgitant jets assessed by colour Doppler, valve annulae, and the complex structural relationships observed in congenital heart lesions. 3D echocardiography can be performed from the transthoracic or transoesophageal approach. The 3D echocardiographic technique has the potential to decrease the time required for complete image acquisition of the heart. Also, the 3D echocardiogram can be viewed from various projections by rotation of the images resulting in an improved appreciation of the relationships between various cardiac structures.

Up until recently, 3D echocardiography was primarily a research tool because off-line image reconstruction from a series of component 2D images was required (reconstruction technique) and this was very time consuming. However, advances in transducer technology now enable the acquisition of a 3D volume of ultrasound data (volumetric technique) and real-time 3D echocardiographic display. This has brought 3D cardiac ultrasound imaging into the clinical realm. This review will focus primarily on this new volumetric technique. 


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  1. See post from 1/27/2010:

    Comparison of Aortic Root Dimensions and Geometries Before and After Transcatheter Aortic Valve Implantation by 2-and 3-Dimensional Transesophageal Echocardiography and Multislice Computed Tomography.
    Arnold C.T. Ng, Victoria Delgado, Frank van der Kley, Miriam Shanks, Nico R.L. van de Veire, Matteo Bertini, Gaetano Nucifora, Rutger J. van Bommel, Laurens F. Tops, Arend de Weger, Giuseppe Tavilla, Albert de Roos, Lucia J. Kroft, Dominic Y. Leung, Joanne Schuijf, Martin J. Schalij, Jeroen J. Bax.
    Circ Cardiovasc Imaging. 2010; 3(1):94-102.

  2. Great review! Eespecially for someone like me with little experience in the echocardiographic arena.

    It seems like 3D echocardiography suffers from some of the same issues as MDCT or MRI, using multi-segment reconstruction with the issues of mis-registration related to irregular heart rates.

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