• 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