Original article
Real-time 3-Dimensional Echocardiographic Imaging of Congenital Heart Disease Using Matrix-array Technology: Freehand Real-time Scanning Adds Instant Morphologic Details Not Well Delineated by Conventional 2-Dimensional Imaging

https://doi.org/10.1016/j.echo.2005.09.009Get rights and content

Objective

We sought to investigate whether real-time (RT) 3-dimensional echocardiography (RT3D) using matrix-array technology could resolve a specific morphologic detail that could not be well resolved during conventional 2-dimensional (2D)/Doppler echocardiographic imaging of congenital heart disease.

Background

Although 2D echocardiography is currently the primary imaging modality of congenital heart disease, there are still some anatomic details that cannot be well delineated by that modality.

Methods

In all, 70 patients underwent RT3D examination using matrix-array transducer. Applying the standard sweeping technique as for 2D imaging, freehand RT imaging was used for immediate feedback. The 2D examinations of the last 23 consecutive patients were used to validate the additional value of RT3D by 3 examiners blinded to the findings of RT3D.

Results

The adequacy of 2D imaging to resolve the morphologic detail in question ranged from 30% to 70%, whereas RT3D imaging was considered successful in delineating the morphologic detail in 80% to 100% of patients instantly. The image resolution was superior or equivalent to that obtained by 2D imaging. Heart valves, septal defects, and volumetric valvular and vascular color flow morphologies were well delineated by RT3D.

Conclusion

Matrix-array RT3D is a significant breakthrough technology that allowed instant visualization of cardiac anatomic details that could not be well delineated by 2D imaging. Further improvements of some technical limitations should make RT3D matrix-array cardiac imaging a significant modality in the field of echocardiographic imaging of congenital cardiac anomalies.

Section snippets

Patients

A total of 70 patients with various simple or complex congenital heart defects underwent echocardiographic examination as a part of their routine clinical care. Age ranged from newborn infants to 38 years, with a median age of 3 years. The spectrum of cardiac lesions ranged from simple defects such as atrial septal defect (ASD) and ventricular septal defect (VSD) to complex lesions such as hypoplastic left heart syndrome, Ebstein’s anomaly, and heterotaxy syndrome (Table 1). The

Results

The patient characteristics and the findings of RT3D are summarized in Table 1. In 23 patients, the question concerned the morphology of the atrioventricular valve (AVV) and the mechanism and origin of the valve regurgitation. This included mitral (Figure 1), tricuspid (Figure 2), and common AVV, both in simple and complex lesions. In RT3D, the leaflets of the AVV were seen from both the ventricular and atrial perspectives. Color flow display of the valvular regurgitation was similar to 2D

Discussion

Among the innovative techniques that have been developed in pediatric echocardiography, RT3D has one of the most important potential applications for day-to-day clinical care.1, 2 The use of earlier versions of RT3D in echocardiographic diagnosis of congenital heart disease has been documented and validated both clinically and in vitro.10, 11 However, these earlier attempts relied on offline analyses of reconstructed images, which was cumbersome, was time-consuming, and produced poor images

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