Three-dimensional (3D) echocardiography has been conceived as one of the most promising methods for the diagnosis of valvular heart disease, and recently has become an integral clinical tool thanks to the development of high quality real-time transesophageal echocardiography (TEE). In particular, for mitral valve diseases, this new approach has proven to be the most unique, powerful, and convincing method for understanding the complicated anatomy of the mitral valve and its dynamism. The method has been useful for surgical management, including robotic mitral valve repair. Moreover, this method has become indispensable for nonsurgical mitral procedures such as edge to edge mitral repair and transcatheter closure of paravaluvular leaks. In addition, color Doppler 3D echo has been valuable to identify the location of the regurgitant orifice and the severity of the mitral regurgitation. For aortic and tricuspid valve diseases, this method may not be quite as valuable as for the mitral valve. However, the necessity of 3D echo is recognized for certain situations even for these valves, such as for evaluating the aortic annulus for transcatheter aortic valve implantation. It is now clear that this method, especially with the continued development of real-time 3D TEE technology, will enhance the diagnosis and management of patients with these valvular heart diseases.

Role of modern 3D echocardiography in valvular heart disease

3D echocardiography: the present and the future.

Three-dimensional (3D) echocardiography is one of the most promising methods for the diagnosis of cardiac disease. Left and right ventricular size and function are currently evaluated with 2D echocardiography. However, for unpredictable asymmetry of the chamber geometry, conventional 2D echocardiography cannot be used to accurately determine absolute chamber volumes and ejection fraction. As for valvular heart diseases, the 3D echo approach has proven to be the most unique, powerful, and convincing method for understanding the complicated anatomy of the valves and their dynamism. The method has been useful for surgical management, including robotic mitral valve repair. Moreover, this method has become indispensable for nonsurgical procedures such as edge-to-edge mitral valve repair. Color Doppler 3D echo has also been valuable to identify the location of the regurgitant orifice, and the severity and character of the valvular regurgitation. In addition, 3D echo is invaluable in the diagnosis and management of congenital heart disease and in certain other situations, such as evaluation of the aortic annulus for transcatheter aortic valve implantation or replacement. It is now clear that 3D echocardiography, especially with the continued development of real-time 3D transesophageal echo technology, will enhance the diagnosis and management of patients with heart diseases.

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Clinical application of 3-dimensional echocardiography in the USA.

The role of left ventricular assist devices (LVAD) in patients with end-stage heart failure is well known, both as a temporary treatment before transplantation and as destination therapy, in a scenario of a relative shortage of donors to satisfy the increasing requests for transplantation. The increased population of LVAD patients needs careful imaging assessment before, during, and after LVAD implantation; echocardiography is the best tool for their evaluation and is considered the diagnostic technique of choice for the assessment before, during, and after device implantation. Although the conventional echocardiographic assessment is quite effective in evaluating the main critical issues, the role of new technologies like three-dimensional echocardiography and myocardial deformation measurements is still not properly clarified. In this review, we aim to provide an overview of the main elements that should be considered in the assessment of these patients, underlining the role that could be played by new techniques to improve the diagnostic and prognostic effectiveness of echocardiography in this setting.

Role of Echocardiography in the Evaluation of Left Ventricular Assist Devices: the Importance of Emerging Technologies

J Echocardiogr Vol.3, No.3, 2005 93 3D cardiac ultrasound is a promising imaging technology currently still in development, which can provide intuitive recognition of cardiac structures from any spatial point of view and may provide complete information about absolute heart chamber volumes and functions. Although there are still severe limitations to the currently available 3D ultrasound methods due to its system complexity and relatively low image quality, this method would be one of the ultimate goals of cardiac imaging. Although a number of techniques have been introduced for 3D ultrasound, there exist two fundamentally different methods for 3D ultrasound imaging. One is employing a series of 2D images with ECG and respiratory gating for synchronized reconstruction. The other is real-time 3D ultrasound, which uses massive parallel processing and sparse array technology to obtain 3D volume data in real-time or high speed scanning of 2D planes with rapid motion of the 2D scanner to cover a volumetric space. In either method, there are two major, definite advantages of 3D imaging over conventional 2D echocardiography as follows: 1) Quantification of absolute cardiac chamber volumes, including left ventricle (LV), right ventricle (RV) and left atrial (LA) volumes and their functions, and 2) Visualization of the 3D structure and dynamic motion images of the heart, especially valve structures.

Clinical Application of 3-Dimensional Echocardiography

To date, the assessment of rheumatic mitral stenosis has been based on Doppler methods, which have a high dependence on the hemodinamic conditions and on the planimetry obtained from 2D echo images. Real Time 3D echocardiography has been implemented in the daily clinical practice. It provides high quality 3D images and the acquisition time is very short. In the present work, we try to show the "state of the art" of Real Time 3D echocardiography in the assessment of rheumatic mitral stenosis. These findings are based on the experience of our "Unidad de Imagen Cardiovascular" at the Hospital Clinico San Carlos de Madrid.

http://www.scielo.org.mx/pdf/acm/v75n2/v75n2a14.pdf

Serra

Papers

Usefulness of Real Time 3D echocardiography in assessment of rheumatic mitral stenosis