Three-dimensional echocardiography enhances the assessment of ventricular septal defect.

By 3-dimensional echocardiography, the location, relation to the aortic and tricuspid valve, and the size of the ventricular septal defect was assessed and compared with 2-dimensional echocardiography and intraoperative findings. We concluded that 3-dimensional echocardiography accurately assesses the anatomy of the ventricular septal defect, provides additional information, and can be considered a valuable preoperative diagnostic tool.

Secundum atrial septal defect is a dynamic three-dimensional entity.

BACKGROUND: The aim of this study was to evaluate the diagnostic relevance of 3-dimensional (3D) echocardiography in the assessment of secundum atrial septum defect (ASD2). METHODS AND RESULTS: Twenty-three patients (age 2 to 58 years) with an ASD2 were studied by transthoracic (n = 9) or transesophageal (n = 14) echocardiography for the acquisition of a 3D data set before undergoing surgical repair. Qualitative (location, shape, and structure) and quantitative (largest and smallest anteroposterior and superoinferior diameters) characteristics were analyzed and compared with surgical findings. Intraobserver and interobserver variability were assessed. The gross anatomy of the ASD2, shown by the 3D images, was confirmed by the surgeon in 21 of 23 patients, but the presence of membranous or fenestrated remnants of the valvula foramina ovalis in the defect was not optimally visualized in 7 patients. Three-dimensional echocardiography revealed changes in diameter and shape of the ASD2 during the cardiac cycle. The measured largest and smallest anteroposterior diameters and their intraobserver and interobserver agreement were 274 +/- 12 mm, r = 0. 95 (P <.001), r = 0.92 (P <.001), and 194 +/- 9 mm, r = 0.96 (P <. 001), r = 0.94 (P <.001), respectively. The measured largest and smallest superoinferior diameter and their intraobserver and interobserver agreement were 304 +/- 26 mm, r = 0.90 (P <.001), r = 0.97 (P <.001), and 204 +/- 10 mm, r = 0.83 (P <.001), r = 0.84 ( P <.001), respectively. The correlation coefficient between 2D and 3D echocardiography for the largest anteroposterior and superoinferior diameter was r = 0.69 (P <.001) and r = 0.68 (P =.05), respectively. The correlation coefficient between the measurements from 3D reconstructions and direct surgical measurements was r = 0.20 (P = not significant) and r = 0.57 (P <.05), whereas between 2D and surgery was r = 0.50 (P <.05) and r = 0.26 (P = not significant). CONCLUSIONS: ASD2 has a complex morphology. Three-dimensional echocardiography provides better qualitative and quantitative information on its dynamic geometry, location, and extension as compared with standard 2D echocardiography and might be useful for device selection during catheter-based closure of ASD2.

Use of three-dimensional echocardiography for analysis of outflow obstruction in congenital heart disease.

To evaluate the feasibility and accuracy of 3-dimensional (3D) echocardiography in analysis of left and right ventricular outflow tract (LVOT and RVOT) obstruction, 3D echocardiography was performed in 28 patients (age 4 months to 36 years) with outflow tract pathology. Type of lesion and relation to valves were assessed. Length and degree of obstruction were measured. Three-D data sets were adequate for reconstruction in 25 of 28 patients; 47 reconstructions were made. In 13 patients with LVOT obstruction, 3D echocardiography was used to study subvalvular details in 8, valvular in 13, and supravalvular in 1. Four of these 13 patients had complex subaortic obstruction. In 12 patients with RVOT lesions, 3D echocardiography was used to study subvalvular details in 11, valvular in 12, and supravalvular in 2. Three-dimensional reconstructions were suitable for analysis in 100% of subvalvular LVOT, 77% valvular LVOT, 100% supravalvular LVOT, 100% subvalvular RVOT, 50% valvular RVOT, and 50% supravalvular RVOT. Twenty patients underwent operation, and surgical findings served as morphologic control for thirty-four 3D reconstructions (LVOT 17, RVOT 17). Operative findings revealed an accuracy at subvalvular LVOT of 100%, valvular LVOT 90%, supravalvular LVOT 100%, subvalvular RVOT 100%, valvular RVOT 100%, and supravalvular RVOT 100%. Quantitative measurements could adequately be performed. Three-D echocardiography is feasible and accurate for analyzing both outflow tracts of the heart. Particularly, generation of nonconventional horizontal cross sections allows a good definition of extension and severity of lesions.

Paraplane analysis from precordial three-dimensional echocardiographic data sets for rapid and accurate quantification of left ventricular volume and function: a comparison with magnetic resonance imaging.

OBJECTIVES: Three-dimensional echocardiography (3DE) calculates left ventricular volumes (LVV) and ejection fraction (EF) without geometric assumptions, but prolonged analysis time limits its routine use. This study was designed to validate a modified 3DE method for rapid and accurate LVV and EF calculation compared with magnetic resonance imaging (MRI). METHODS: Forty subjects included 15 normal volunteers (group A) and 25 patients with segmental wall motion abnormalities and global hypokinesis caused by ischemic heart disease (group B) who underwent 3DE with precordial rotational acquisition technique (2-degree interval with electrocardiographic and respiratory gating) and MRI at 0.5 T, electrocardiogram (ECG)-triggered multislice multiphase T1-weighted fast field echo. End-diastolic and end-systolic LVV and EF were calculated from both techniques with Simpson's rule by manual endocardial tracing of equidistant parallel left ventricular short-axis slices. Slicing from the 3DE data sets were done by both 2.9-mm slice thickness (method 3DE-A) and by 8 equidistant short-axis slices (method 3DE-B); for MRI analysis, 9-mm slice thickness was used. RESULTS: Analysis time required for manual endocardial tracing of end-diastolic and end-systolic short-axis slices was 10 minutes for the 3DE-B method compared with 40 minutes by the 3DE-A method. For all 40 subjects the mean +/- SD of end-diastolic LVV (mL) were 181 +/- 76, 179 +/- 73, and 182 +/- 76; for end-systolic LVV (mL), 120 +/- 76, 120 +/- 75, and 122 +/- 77; and for EF (%), 39 +/- 18, 38 +/- 18, and 38 +/- 18 for MRI, 3DE-A, and 3DE-B methods, respectively. The differences between 3DE-A and 3DE-B with MRI for calculating end-diastolic and end-systolic LVV and EF were not significant for the whole group of subjects as well as for the subgroups. The 3DE-B method had excellent correlation and close limits of agreement with MRI for calculating end-diastolic and end-systolic LVV and EF: r = 0.98 (-1.3 +/- 26.6), 0.99 (-1.6 +/- 21. 2), and 0.99 (0.2 +/- 5.2), respectively. The correlation between 3DE-A and MRI were r = 0.97, 0.98, and 0.98, and the limits of agreement were -1.4 +/- 36, -0.6 +/- 26, and 0.6 +/- 8 for calculating end-diastolic and end-systolic LVV and EF, respectively. In addition, excellent correlation and close limits of agreement between 3DE-A and 3DE-B with MRI for LVV and EF calculation was also found for the subgroups. Intraobserver and interobserver variability (SEE) of MRI for calculating end-diastolic and end-systolic LVV and EF were 6.3, 4.7, and 2.1; and 13.6, 11.5, and 4.7; respectively, whereas that for 3DE-B were 3.1, 4.4, and 2.2; and 6.2, 3.8, and 3. 6; respectively. Comparable observer variability was also found for the A and B subgroups. CONCLUSIONS: The 3DE-A and 3DE-B methods have excellent correlation and close limits of agreement with MRI for calculating LVV and EF in both normal subjects and cardiac patients. The 3DE-B method by paraplane analysis with 8 equidistant short-axis slices has observer variability similar to MRI and reduces the 3DE analysis time to 10 minutes, therefore offering a rapid, reproducible, and accurate method for LVV and EF calculation.

Three-dimensional ultrasound study of carotid arteries before and after endarterectomy; analysis of stenotic lesions and surgical impact on the vessel.

BACKGROUND AND PURPOSE: It has been proved that symptomatic patients with severe carotid stenosis benefit from endarterectomy. Currently used methods for quantitation of the severity of carotid stenosis have limitations, and the impact of endarterectomy on the operated region of carotid artery remains unknown. The purpose of this study was to examine the accuracy of a 3-D ultrasound system for quantitation of stenotic lesions and to evaluate changes in regional vessel volume and cross-sectional area after carotid endarterectomy. METHODS: We studied 14 patients with both carotid angiography and 3-D ultrasound. Of 13 patients who underwent surgery, 12 were reexamined with 3-D ultrasound after surgery. The length and volume of 20 randomly selected plaques were measured from 3-D data sets. The severity of stenosis was quantified by 3-D ultrasound using both a diameter method and an area method on cross-sectional views at the most stenotic site; the results were then compared with those from carotid angiography. The segmental vessel volume and average cross-sectional area of the operated artery both before and after endarterectomy were measured from 3-D ultrasound data. RESULTS: Good correlation was obtained between 3-D ultrasound and carotid angiography in quantitative analysis of carotid stenosis (SEE=12.4%, r=0.76, and mean difference=7.0+/-12.3% with the diameter method; SEE=10.5%, r=0.82, and mean difference=1.8+/-10.5% with the area method by 3-D ultrasound). 3-D ultrasound had excellent reproducibility and small intraobserver and interobserver variability in plaque length and volume measurements. No significant changes in segmental vessel volume and average cross-sectional area of the operated artery were observed after surgery in patients with suture closure. However, a significant increase in segmental vessel volume was obtained in patients with polyfluorethylene patches applied to the surgical opening of the artery. CONCLUSIONS: 3-D ultrasound can be used for both qualitative and quantitative analysis of plaques in the carotid artery and to detect and quantify significant carotid stenosis. Its volumetric potential has important clinical implications in serial follow-up studies for observing the progression or regression of stenotic lesions and for evaluating the outcome of interventional procedures such as endarterectomy or stent placement.

Quantification of the aortic valve area in three-dimensional echocardiographic data sets: analysis of orifice overestimation resulting from suboptimal cut-plane selection.

BACKGROUND: Our study was designed to determine the feasibility of three-dimensional echocardiographic (3DE) aortic valve area planimetry and to evaluate potential errors resulting from suboptimal imaging plane position. METHODS AND RESULTS: Transesophageal echocardiography with acquisition of images for 3DE was performed in 27 patients. Aortic valve orifice was planimetered in two-dimensional echocardiograms (2DE) and in two-dimensional views reconstructed from 3DE data sets optimized for the level of the cusp tips. To evaluate the errors caused by suboptimal cut-plane selection, orifice was also measured in cut-planes angulated by 10, 20, and 30 degrees or shifted by 1.5 to 7.5 mm. Planimetered orifice areas was similar in 2DE and 3DE studies: 2.09 +/- 0.97 cm2 versus 2.07 +/- 0.92 cm2. Significant overestimation was observed with cut-plane angulation (0.09, 0.19, and 0.34 cm2 at 10 degree increments) or parallel shift (0.11, 0.22, 0.33, 0.43, and 0.63 cm2 at 1.5 mm increments). Three-dimensional echocardiographic measurement reproducibility was very low and superior to that of 2DE. CONCLUSIONS: Three-dimensional echocardiography allows accurate aortic valve area quantification with excellent reproducibility. Relatively small inaccuracy in cut-plane adjustment is a major source of errors in aortic valve area planimetry.

Cosgrove-Edwards mitral ring dynamics measured with transesophageal three-dimensional echocardiography.

BACKGROUND: Flexible rings have been introduced for improved mitral valve annuloplasty. These rings allow systolic-diastolic variation of both the shape and the area of the valve orifice, mimicking the normal dynamics of the mitral valve ring. In humans, information on the functional behavior of the Cosgrove-Edwards ring during the cardiac cycle is limited at present. METHODS: We used transesophageal three-dimensional echocardiography to analyze mitral valve rings in 19 consecutive patients who underwent annuloplasty because of severe (grade III to IV) mitral regurgitation. Fifteen patients received a Cosgrove-Edwards ring and 4 received a Carpentier ring. The acquisition for three-dimensional reconstruction was performed using the transesophageal rotational technique, immediately after operation. Horizontal cross-sections through the mitral valve ring were selected from the data sets for measurement of the dimensions and surface area of the mitral valve orifice at end-systole and end-diastole. Measurements of the flexible Cosgrove-Edwards ring and the rigid Carpentier ring were compared. RESULTS: Adequate images for measurements were obtained in 17 of 19 patients. The end-systolic orifice area of the Cosgrove-Edwards ring was 4.21 +/- 1.50 cm2 (mean +/- standard deviation) and the end-diastolic area was 4.81 +/- 1.56 cm2 (p < 0.0001). No significant change in the orifice area of the Carpentier ring was observed. CONCLUSIONS: Three-dimensional transesophageal echocardiography allows the functional assessment in vivo of mitral valve annuloplasty rings. The Cosgrove-Edwards ring maintains its flexibility early after implantation and demonstrates significant systolic-diastolic changes in the orifice area during the cardiac cycle.

Prognostic significance of ventricular extrasystoles in healthy professional athletes: results of a 5-year follow-up.

To assess the natural history of ventricular extrasystoles (VE), a 5-year follow-up of 52 professional endurance athletes was made. All remained well during this period. Forty-four accepted to undergo repeat extensive noninvasive cardiologic examination. In the 23 athletes still in activity at the second study the prevalence of total and complex VE at 24-hour Holter monitoring was substantially unchanged, while in the 21 subjects who had stopped training, complex VE were no longer present (p = 0.01 vs. baseline). Echocardiographic dimensional parameters were significantly higher in the still active athletes than in the no longer active subjects; however, in the latter, left ventricular mass index was still greater than in a group of 40 sedentary subjects previously studied (107 vs. 81 g/m2; p = 0.001). High-intensity physical training does not seem to be harmful in athletes with complex VE, without evidence of underlying cardiac disease.