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Abstract and Introduction
Abstract
Aim of the work To evaluate the feasibility and possible additional value of transthoracic real-time three-dimensional echocardiography (RT3D-TTE) for the assessment of cardiac structures as compared to 2D-TTE.
Methods 320 patients (mean age 45 ± 8.4 years, 75% males) underwent 2D-TTE and RT3D-TTE using 3DQ-Q lab software for offline analysis. Volume quantification and functional assessment was performed in 90 patients for left ventricle and in 20 patients for right ventricle. Assessment of native (112 patients) and prosthetic (30 patients) valves morphology and functions was performed. RT3D-TTE was performed for evaluation of septal defects in 30 patients and intracardiac masses in 52 patients.
Results RT3D-TTE assessment of left ventricle was feasible and reproducible in 86% of patients while for right ventricle, it was (55%). RT3D-TTE could define the surface anatomy of mitral valve optimally (100%), while for aortic and tricuspid was (88% and 81% respectively). Valve area could be planimetered in 100% for the mitral and in 80% for the aortic. RT3D-TTE provided a comprehensive anatomical and functional evaluation of prosthetic valves. RT3D-TTE enface visualization of septal defects allowed optimal assessment of shape, size, area and number of defects and evaluated the outcome post device closure. RT3D-TTE allowed looking inside the intracardiac masses through multiple sectioning, valuable anatomical delineation and volume calculation.
Conclusion Our initial experience showed that the use of RT3D-TTE in the assessment of cardiac patients is feasible and allowed detailed anatomical and functional assessment of many cardiac disorders.
Introduction
Conventional 2-dimensional echocardiography (2DE) has been established as the most widely diagnostic tool that helps in morphological and functional assessment of cardiac chambers and valves. Despite the advancement in technology of echo machines and its analysis software, 2DE application still carries many limitations particularly with complex anomalies and cardiac chamber quantification. It requires mental conceptualization of a series of multiple tomographic images into an imaginary multidimensional reconstruction. Many of 2DE formulas used for volume quantification and ejection fraction calculation especially for left ventricle (LV) are based on geometric assumption that may not be accurate in the setting of chamber dilatation or distortion and in the presence of regional wall motion abnormalities. Interobserver variability for 2DE images interpretation is still wide due to different ways of data interpolation especially for measurement of mitral and aortic valve orifice area. Imaging of the heart in 3D provides better understanding and assessment of cardiac structures in a real shape. The advanced technology of matrix array transducer improved the contrast resolution and penetration and enabled to image the entire heart by a pyramidal full-volume acquisition of four cardiac cycles. The development in 3D software made the off-line data analysis faster and easier and improved both temporal and spatial resolution of the images. We report our experience with real-time 3D-transthoracic echocardiography (RT3D-TTE) in comparison with 2D-TTE for the assessment of different cardiac conditions.
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