3D Echocardiography in Congenital Heart Disease – Dr Els Van Laeken

3D Echocardiography in Congenital Heart Disease – Dr Els Van Laeken

General

  • 3D echo = extra value and information (not replacing 2D)
  • 3D echo ≠ method to repair bad 2D images
  • Initially: offline analysis → long breath holding, time consuming, results often too late
  • matrix array transducers: all elements transmit and receive electronically, live 3D real time possible, no offline reconstruction necessary (no postprocessing)

 

Live 3D

  • takes a pyramid of data
  • real time (“what you see is what you get”)
  • no stitch artifacts
  • low frame rate
  • always hit ‘acquire’ button
  • ability to rotate and cut in any plane → development of novel views (e.g. from atrial or ventricular side; anatomical view, surgeon’s view, …)

 

3D zoom

  • takes a smaller, magnified pyramidal dataset at high resolution
  • to focus on a specific area of interest
  • no stitch artifacts
  • higher frame rate
  • not ECG gated
  • possibility to add colour but lowers frame rate
  • orientation is important (include some external landmarks)

 

3D full volume

  • acquires pieces of segments over successive cardiac cycles
  • multibeat acquisition: 2 – 4 – 6 cardiac cycles, stitched together
  • ECG must be attached!
  • artifacts when movement of patient (suspend breathing)
  • ↑cycles → ↑frame rate, but also ↑acquisition time and ↑risk stitch artifacts
  • ‘one beat acquisition’ possible but not as good, ↓spatial resolution
  • possibility to add colour (e.g. evaluate AV regurgitation), but difficult: long acquisition time, ↑stitch artifacts

 

Example: imaging mitral valve with 3D zoom TOE (EPIQ, Philips)

  • obtain a ME four chamber view (0-20°)screen-shot-2016-10-04-at-4-41-49-pm
  • optimise gain settings (TGC/LGC) to avoid any overly bright or dark areas
  • touch 3D zoom button
  • 2 reference images will appear on the monitor: standard scanning plane (four chamber view) on the left and the orthogonal/elevation plane (two chamber view) on the right
  • position the 3D zoom box over the area of interest in the reference image on the left hand side of the monitor
  • use the tracking ball to move the position of the box and the surrounding buttons to adjust the size of the box
  • ensure all the anatomy of interest is included: i.e. the mitral valve and annulus but also some usefull landmarks to assist you in orientation later on (e.g. part of the aortic valve)
  • don’t make the zoom box too wide or too high: that will lower your frame rate
  • adjust the width of the zoom box in the elevation plane on the right hand side of the monitor
  • touch the 3D zoom button again to acquire a 3D image on the screen
  • rotate the tracking ball to look at the mitral valve from the left atrium (rotate towards you) or from the left ventricle (rotate away from you)
  • use the rotating knob below ‘rotate Z’ on the touch screen to rotate the 3D image
  • for the surgeon’s view: use the tracking ball to get an en face view of the mitral valve from the LA side, use the rotate Z knob until the AV is in the 12 o’clock position and the LA
    appendage appears on the left
  • adjust gain by rotating the 3D knob (overgain will obstruct the anatomy by brown speckle, undergain will create ‘holes’ in the anatomy)
  • hit ‘acquire’ to save the 3D image

About The Author

Structural Heart Disease Australia

Structural Heart Disease Australia is an incorporated association focused on education in valvular and structural cardiac diseases. It was started by group of echocardiographers, anaesthetists, clinical and interventional cardiologists, and cardiothoracic surgeons to provide a useful learning resource for medical professionals.

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