3D echo evolution .

Phillip D’Amato.

Outline.

Introduction to 3d echo.Advances in 3d echo.3d echo technical tips.3d echo and cardiac valve disease.3d echo quantification.3d echo in emboli.3d echo in stenosis.Future directions of the technology.

Introduction to 3D echo.Three dimensional echocardiography has

quickly taken the cardiovascular profession by storm. Since its introduction into mainstream cardiology in 2000,3D echo has changed the way routine echo's are performed and surgical operations are planned in the modern healthcare environment.3D echo has brought an evolutionary change to the field of echocardiography.

Introduction to 3D echo. Researchers worked diligently in the 1970s to

create three dimensional echo. There were many failures and technical difficulties.

Improved processing power and transducer technology allowed for Von Ramn and colleagues at Duke University to obtain complete volume rendition of the heart in single plane (Swaminathan p.1).

3D produces images on the X YZ axis to allow a very detailed image of the height, width , depth of the human heart.

Advances in 3D echo.

3D echo has been extensively used in the past few years for its ability to enhance the understanding of failed and failing cardiac valves.

This new understanding is at the forefront of clinical interventions which used in 3d echo in both the planning and real time operational stage for valve repairs, closure of cardiac defects ,etc.

3D echo technical tips. 3D echo is a wonderful tool for the cardiac

sonographer.The sonographer must be aware of few critical things to get great images from 3d echo.

Gains are extremely important in 3d echo. Its best to slightly under gain 3d images to achieve peak visualization.This is true also for 3d echo TEE.

Cropping is extremely important to the sonographer The sonographer needs to use cropping to cut into the data set.This may take quite some time to learn.

3D echo and cardiac valves.3D echo has also played a role in better

understanding of prosthetic valve function ,as well as, help discover dysfunctional parameters. Real time 3D echo is currently used in the cath lab to help assess proper valve placement and positioning.

One concern for Mitral valve replacement is Perivalvular dehiscence.3D echo is a wonderful tool for diagnosing this complication of prosthetic valves.

3D echo Quantification. Perivalvular dehiscence occurs in 2 -17 % of

cases following MV replacement(Naqvi & Qamruddin , 2011 p.1437).

3D TEE has also been used when these leaks are closed via closure devices ,and its been used to calculate effective circumferential orifice length of these leaks(Naqvi & Qamruddin , 2011 p.1437)

Mitral clip.3D echo has been used with great success in

mitral clip procedures. These procedures use a clip device that’s tightens the leaflet connection to reduce large mitral murmurs. These procedures are often done with 3d echo guidance for device replacement.

3d echo supports safe guidance of clip delivery system via left atrium to the mitral valve, exact positioning of the clip in the middle of the intercommisural line at the center of the jet and accurate alignment of the clip

Mitral Clip and TAVR.Arms perpendicular to the intercommisural

line(Naqvi & Qamruddin , 2011 p.1437 ). Three dimensional echo has also begun to

show promise in the field of TAVR aortic valve replacements.Today,this new procedure is using 3d echo to guide the insertion of this valves into proper alignment.

3d TEE is the preferred method for these types of procedures.

3D echo role in emboli cases.Three dimensional echo has been utilized to aid

in the search for embolus in the left atria. Researchers have begun to use three dimensional echo to assess shape of left atria in cases of mitral stenosis for early embolus formation.

Recent clinical research has uncovered some intriguing new data about shape of left atria and its role in clots. Specifically, research has found that a spherical shape left atria leads to clot formation due to stagnant blood flow(Nunes ,et al 2012 ).

3D echo role in emboli cases.Researchers correlated that spherical shape

leads to a increased predisposition to clot formation with some new novel thinking.

Researchers used 101 consecutive patients with MS, SR, and no other significant valve disease. Left atria volume indexed to BSA and transverse cross sectional area were measured by 3d echo(Nunes ,et al ,2012). Left atria shape was then then assessed by the ratio of the measured to calculated LAV.

3D echo role in aortic stenosis.

Researchers have also begun to you use 3d echo to assess aortic valve stenosis.The work has begun to reveal intriguing things about the aortic valve. Work on clinical measurements between both 2d AVA and 3d AVA measurements correlate well with 2d AVA but is smaller suggesting that the AS orifice is not planer but is more of a tunnel than a flat ring(Hussam, et al , 2010).

Future Directions of 3D echo.Today, there is much ongoing research being

conducted on 3d echo. Improvements will continue to be made in both software and transducer design. Research continues on finding ways to use assess myocardial viability with 3d echo ultrasound.3D stress echo should be perfected in a few years.

There still remains much work to do in both 3d echo

best practices for imaging utilization and measurement standardization.

References.1.Swaminathan,Madhav.What is and how to do 3D echocardiography. Retrieved April 1, 2013 from www.

Duke medicine.org

2 .Qamruddinn, Salima,Naqvi,Taneem.(2011).Advances in 3d echocardiography for mitral valve. Expert review of cardiovascular therapy. 9(11).1431-1443.

References.3.Nunes,M;Handscumacher;Mark,Marcia,Barbosa, Levine, Robert.(2012). The role of left atria shape in predicting embolic events in mitral stenosis. JACC, 59(13), 1969.4.Hussam,S;Byers;S,Green-hess,Irmina,Pizlo; Feigenbaum,H.(2010).Feasibility of using real time echocardiography to visualize the stenotic aortic valve. Echocardiography,27(8),1011-1020.