Textbook of Real-Time Three Dimensional Echocardiography (eBook)

Textbook of Real-Time Three Dimensional Echocardiography 2
Foreword 4
Preface 5
Contents 6
Contributors 8
1: The Evolution of Three-Dimensional Echocardiography: How Did It Happen 10
1.1 Linear Multiplane Scanning 10
1.2 Gated Sequential Acquisition 10
1.3 Transesophageal Rotational Imaging 11
1.4 Transthoracic Rotational Imaging 11
1.5 Transthoracic Free-Hand Imaging 11
1.6 Transthoracic Real-Time 3D Imaging 13
1.7 From Gated to Single-Beat Acquisition 14
1.8 Transesophageal Real-Time Imaging 14
1.9 Display of 3D Image Information 14
1.10 Volumetric Quantification 16
1.11 Summary 17
References 17
2: Technical Principles of Transthoracic Three-Dimensional Echocardiography 18
2.1 Introduction 18
2.2 3D Transducer Design and Technology 18
2.3 Beamforming in Three Spatial Dimensions 20
2.4 Frame Rate, Volume Size and Spatial Resolution 20
2.5 3D Displays 22
2.5.1 Slice Rendering 22
2.5.2 Volume Rendering 23
2.5.3 Surface Rendering 25
2.6 3D Imaging Modes 25
2.6.1 Multi-plane Imaging 25
2.6.2 3D Tissue Imaging 25
2.6.3 3D Color Doppler Imaging 26
2.6.4 Contrast Enhanced 3D Imaging 26
2.7 Image Artifacts 26
2.8 Measuring in Three Dimensions 26
2.8.1 Distances and Areas 26
2.8.2 Left Ventricular (LV) Volumes and Ejection Fraction (EF) 27
2.8.3 Other LV Measurements 28
2.8.4 Left Atrium and Right Ventricle 29
2.8.5 3D Color Doppler Quantification 29
2.8.6 Quantification of Mitral Valve Apparatus 29
2.9 Future Developments 29
2.9.1 Transducer Technology 29
2.9.2 3D Beamforming 30
2.9.3 Portable 3DE 30
2.9.4 Data Processing 30
2.9.5 3D Monitors 30
2.9.6 Navigation 30
2.9.7 3D Stress Echocardiography 30
2.9.8 Perfusion Imaging 31
2.9.9 Quantification 31
2.9.10 Image Registration and Fusion 31
2.9.11 Connectivity 31
2.10 Concluding Remarks 31
References 32
3: 3D Transesophageal Echocardiographic Technologies 34
3.1 Introduction 34
3.2 Transducer Technology 34
3.3 Beamforming 36
3.4 Quantification for 3D TEE 38
3.5 Procedural Guidance for 3D TEE 39
References 40
4: Three-Dimensional Echocardiography in Clinical Practice 42
4.1 The Incremental Value of the Third Dimension 42
4.2 Acquisition Modes 42
4.3 How to Navigate Within the 3D Data Set and Visualize the Desired Cardiac Structure? 45
4.4 How to Handle the Present 3D Transducers Technology and the Impact of 3D on Lab Work Flow 49
4.5 Acquisition Protocols and Imaging Views 52
References 53
5: Advanced Evaluation of LV Function with 3D Echocardiography 54
5.1 Left Ventricular Volumes and Ejection Fraction 54
5.2 Left Ventricular Mass 56
5.3 Left Ventricular Wall Motion 57
5.4 Uses of Contrast with Real-Time 3D Echocardiography 58
5.4.1 Chamber Opacification 58
5.5 Myocardial Perfusion 59
5.6 Limitations of 3DE Evaluation of the Left Ventricle 59
5.7 Future Developments 60
5.8 Disclosure 61
References 61
6: Three-Dimensional Echocardiographic Evaluation of the Mitral Valve 63
6.1 Three-Dimensional Echocardiographic Anatomy of the Normal Mitral Valve 63
6.2 Mitral Valve Regurgitation 63
6.2.1 Organic Mitral Valve Regurgitation 64
6.2.2 Functional Mitral Valve Regurgitation 64
6.2.3 Assessment of the Degree of Regurgitation 65
6.2.4 Postoperative Assessment of Mitral Valve Repair 66
6.3 Mitral Valve Stenosis 66
6.3.1 Morphological Assessment 66
6.3.2 Functional Assessment 66
6.3.3 Monitoring Percutaneous Mitral Valvuloplasty 68
6.4 3D Echocardiography in the Evaluation of Prosthetic Valves 69
6.5 Mitral Valve Endocarditis 69
6.6 Disclosure 69
References 69
7: Three Dimensional Echocardiographic Evaluation of LV Dyssynchrony and Stress Testing 71
7.1 Assessment of Intraventricular Dyssynchrony 71
7.1.1 Do We Really Need 3D Echocardiography? 71
7.1.2 How to Assess Mechanical LV Dyssynchrony with 3D Echocardiography 71
7.1.2.1 The Systolic Dyssynchrony Index 72
7.1.2.2 Normal Values and Reproducibility of SDI 73
7.1.3 Usefulness of SDI in Predicting the Results of CRT 74
7.1.4 Comparison of SDI with Other Methods of Assessing Dyssynchrony 75
7.1.4.1 Gated Myocardial Perfusion Single Photon Emission Computed Tomography (GMPS) 75
7.1.4.2 Magnetic Resonance Imaging (MRI) 75
7.1.4.3 Tissue Doppler Imaging (TDI) 76
7.1.5 Other Applications of 3D Echocardiography in Dyssynchrony Assessment 76
7.1.5.1 Assessment of the Latest Contracting Segment 76
7.1.5.2 Triplane TDI 76
7.1.6 Conclusions: Future Directions 77
7.2 Three-Dimensional Stress Echocardiography 77
7.2.1 Rationale for Using 3D for Stress Echocardiography: Limitations of 2D Echocardiography 77
7.2.2 Modes of Using 3D Echocardiography in Stress Echocardiography: Pros and Cons 78
7.2.3 Feasibility of 3D Stress Echocardiography: Use of Contrast 79
7.2.4 Acquisition Time 81
7.2.5 Reproducibility of 3D Stress Echocardiography 81
7.2.6 Diagnostic Accuracy of 3D Stress Echocardiography 81
7.2.7 Conclusions: Future Directions 82
7.3 Three-Dimensional Speckle Tracking 83
7.3.1 Theoretical Advantages and Limitations of 3D Compared to 2D Speckle Tracking 83
7.3.2 How to Perform 3D Speckle Tracking 83
7.3.3 Existing Data: Reproducibility of the Method 84
7.3.4 Conclusions: Future Directions 84
7.4 Assessment of Myocardial Perfusion Using 3D Echocardiography 84
7.4.1 Theoretical Advantages of 3D Compared to 2D Echocardiography for Assessment of Myocardial Perfusion 84
7.4.2 Weight of Evidence for 3D Myocardial Perfusion: Limitations to Overcome 84
7.4.3 Conclusions: Future Directions 85
References 85
8: Three-Dimensional Echocardiography of Aortic Valve 89
8.1 Introduction 89
8.2 Methods 89
8.3 3D Imaging in Aortic Valve Disease 90
8.4 Morphological Assessment 91
8.5 Clinical Applications of 3DE in Aortic Stenosis 92
8.6 Aortic Regurgitation 95
8.7 Intraprocedural Studies of Aortic Valve 96
8.8 Summary and Perspectives 96
References 101
9: Three-Dimensional Echocardiographic Evaluation of the Right Ventricle 104
9.1 The Right Ventricle 104
References 107
10: Three-Dimensional Echocardiography in Congenital Heart Disease 109
10.1 Introduction 109
10.2 Clinical Applications 109
10.3 Visualization of Morphology 109
10.3.1 The Atrioventricular Valves 109
10.3.2 Atrioventricular Septal Defect 109
10.3.3 The Atrial and Ventricular Septa 110
10.3.4 The Aortic Arch, Pulmonary Arteries and Aortopulmonary Shunts 110
10.3.5 The Aortic Valve and Outflow Tract 111
10.3.6 Characterization of Left Ventricular Noncompaction 111
10.4 Quantitation of Chamber Dimensions, Valve Apparatus, Function and Flows 111
10.5 Left Ventricular Volumetrics in Children 112
10.6 Left Ventricular Mass 112
10.7 Left Ventricular Dyssynchrony 112
10.8 Right Ventricular Volumetrics 112
10.9 Visualization and Quantitation of 3DE Color Flow 113
10.10 Pressure:Volume Loops 113
10.11 Image-Guided Intervention: Trans-thoracic 3DE 113
10.12 Image-Guided Intervention: Trans-esophageal 3DE 113
10.13 Learning Curve 114
10.14 Future Directions 114
10.15 Conclusion 115
References 115
11: Three-Dimensional Echocardiography to Assess Intra-cardiac Masses 117
11.1 Introduction 117
11.2 Echocardiographic Assessment of Intra-cardiac Masses 117
11.3 The 3D Examination 117
11.4 Real Time 3D Evaluation of Cardiac Masses 117
11.5 Differential Diagnosis 118
11.6 Added Value of 3D Echocardiography in the Assessment of Intra-cardiac Benign, Malignant, and Metastatic Cardiac Tumors 119
11.6.1 Unlimited Slicing and Cropping 119
11.6.2 Evaluation of the Composition of the Mass 119
11.6.3 Unparalleled Level of Anatomic Detail 119
11.6.4 Evaluation of the Size of the Cardiac Mass 120
11.7 Visualization of the True Apex,and Calculation of Left Ventricular Volumes and Ejection Fraction 121
11.8 Evaluation of Associated Abnormalities 121
11.9 Surgical Planning 121
11.10 Added Value in the Evaluation of Embryonic Remnants and Normal Variants 122
11.11 Added Value in the Evaluation of Thrombi 122
11.11.1 Apical Thrombi 122
11.11.2 Thrombi and the Left Atrial Appendage 123
11.12 Added Value in the Evaluation of Masses Associated with Cardiomyopathy 123
11.13 Added Value in the Evaluation of Masses and Complications Associated with Devices 124
11.14 Conclusions 124
11.15 Disclosure 124
References 125
12: Real Time Three Dimensional Transesophageal Echocardiography for Guidance of Catheter Based Interventions 126
12.1 Introduction 126
12.2 General Considerations 126
12.3 Specific Procedures 127
12.3.1 Atrial Septal Defect and Patent Foramen Ovale Closure 127
12.3.2 Percutaneous Closure of Ventricular Septal Defect 128
12.3.3 Mitral Valve Clipping 128
12.3.4 Mitral Balloon Valvulotomy for Mitral Stenosis 129
12.3.5 Percutaneous Closure of Prosthetic Valve Dehiscence 130
12.4 Catheter-Based Aortic Valve Implantation 131
12.5 Left Atrial Appendage Obliteration 133
12.6 Pulmonary Vein Ablation for Atrial Fibrillation 135
12.7 Current Status and Future Directions 135
References 136
13: Future Developments of Three-Dimensional Echocardiography 139
13.1 Transducer Technology 139
13.2 Data Set Navigation and Image Display 140
13.3 Quantification 141
13.4 Connectivity 142
References 142
14: Real-Time Three-Dimensional Transesophageal Echocardiography 143
14.1 Overview 143
14.2 Technology 143
14.2.1 First Developments: The Rotational Concept 143
14.2.2 Current Technology: The Azimuthal Revolution 144
14.3 Relevant Cardiac Anatomy in Real-Time Transesophageal 3DE 145
14.4 Clinical Applications 147
14.4.1 Intraoperative Echocardiography 147
14.4.2 Percutaneous Catheter and Device-Based Procedures 147
14.4.3 Radiofrequency Catheter Ablation of Atrial Tachyarrhythmias 149
14.5 Challenges and Future Perspectives 149
References 150
15: The Role of Echocardiography in the Surgical Management of Degenerative Mitral Valve Disease 151
15.1 Mitral Valve Anatomy 151
15.1.1 Mitral Annulus 151
15.1.2 Mitral Valve Leaflets 151
15.1.3 Mitral Valve Commissures 152
15.1.4 Mitral Valve Chordae 152
15.1.5 Mitral Valve Papillary Muscle and the Left Ventricle 152
15.2 Quantitation of Mitral Regurgitation 153
15.3 Mitral Valve Imaging 154
15.3.1 Mid-esophageal Four-Chamber View 154
15.3.2 Mid-esophageal Bi-commissural View 154
15.3.3 Mid-esophageal Two-Chamber View 155
15.3.4 Mid-esophageal Long-Axis View 155
15.3.5 Transgastric Basal Short-Axis View 155
15.4 Real Time Transesophageal 3D Echocardiogram 156
15.5 The Pathophysiologic Triad of Mitral Valve Disease 157
15.6 Post-Repair Assessment 160
References 162
16: Visualization and Assessment of Coronary Arteries with Three-Dimensional Echocardiography 164
16.1 Introduction 164
16.2 The Detection of Coronary Arteries and Coronary Artery Flow by Conventional Echocardiography 165
16.3 The Detection of Coronary Arteries and Coronary Artery Flow by 3D Echocardiography: Methodological Aspects 165
16.4 Limitations 169
16.5 Summary 170
16.6 Conclusions 170
References 173
17: Assessment of Tricuspid Valve Morphology and Function 175
17.1 Introduction 175
17.2 Anatomy of Tricuspid Valve 175
17.3 Approaches to 3D Imaging of the Tricuspid Valve 175
17.4 Tricuspid Regurgitation 178
17.5 Tricuspid Stenosis 181
17.6 Infective Endocarditis of the Tricuspid Valve 183
17.7 Congenital 183
17.8 Present Limitations and Future Perspectives 183
17.9 Conclusions 183
References 184
18: Role of Three-Dimensional Echocardiography in Drug Trials 185
18.2 Left Ventricular Geometry and Function 186
18.2.1 Left Ventricular Size, Wall Thickness and LV Volumes 186
18.2.2 Left Ventricular Mass and Geometry 186
18.2.3 Left Ventricular Global and Regional Systolic Function 187
18.2.3.1 LV Regional Function 189
18.2.4 How to Increase Accuracy of Left Ventricular Measurements 189
18.2.4.1 Performance Recommendations 189
18.2.4.2 Reading Recommendations 189
18.3.1 Right Ventricular Size 189
18.3.2 Right Ventricular Function 191
18.3 Right Ventricular Size and Function 189
18.4 Left Atrial Size and Function 191
18.4.1 Left Atrial Volume 191
References 192
Index 195