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How to Implement Three-Dimensional Echocardiography in the Routine of the Echocardiography Laboratory

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Textbook of Three-Dimensional Echocardiography

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Abstract

The advent of three-dimensional echocardiography (3DE) represented a real breakthrough in cardiovascular ultrasound. Major advancements in computer and transducer technology allow to acquire 3D data sets with adequate spatial and temporal resolution for assessing the functional anatomy of cardiac structures in most of cardiac pathologies. Compared to conventional two-dimensional echocardiographic (2DE) imaging, 3DE allows the operator to visualize the cardiac structures from virtually any perspective, providing a more anatomically sound and intuitive display, as well as an accurate quantitative evaluation of anatomy and function of heart valves. In addition, 3DE overcomes geometric assumptions and enables an accurate quantitative and reproducible evaluation of cardiac chambers, thus offering solid elements for patient management. Furthermore, 3DE is the only imaging technique based on volumetric scanning able to show moving structures in the beating heart, in contrast to cardiac magnetic resonance (CMR) or cardiac computed tomography (CT), which are based on post-acquisition 3D reconstruction from multiple tomographic images and displaying only 3D rendered snapshots.

Data regarding clinical applications of 3DE are burgeoning and gradually capturing an established place in the noninvasive clinical assessment of anatomy and function of cardiac structures. Recently, joint European Association of Echocardiography and American Society of Echocardiography recommendations have been published, aiming to provide clinicians with a systematic approach to 3D image acquisition and analysis. Finally, the recent update of the recommendations for the chamber quantification using echocardiography recommended 3DE for the assessment of the left and right ventricular size and function. However, despite all these evidences 3DE has not yet been adopted for the clinical routine in most echocardiography laboratories. This chapter tries too identify the bareers that have hampered the diffusion of 3DE in the clinical arena and to offer some practical advices on how to implement 3DE in the clinical practice.

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Authors and Affiliations

  1. University of Milano-Bicocca, and Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Milano, Italy

    Denisa Muraru & Luigi P. Badano

Authors
  1. Denisa Muraru
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  2. Luigi P. Badano
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Corresponding author

Correspondence to Luigi P. Badano .

Editor information

Editors and Affiliations

  1. University of Milano-Bicocca and Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Milano, Italy

    Luigi P. Badano

  2. Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA

    Roberto M. Lang

  3. University of Milano-Bicocca and Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Milano, Italy

    Denisa Muraru

Electronic Supplementary Material

Image 4.1

(Stitching) Multibeat Acquisition multi-beat full volume Acquisition full volume acquisition. Volume rendering of a mitral valve with clear separation of subvolumes due to several issues with the ECG trace: prominent P wave which is triggered together with the R wave; deep S wave triggered together with the R wave; ventricular ectopic beat (TIF 2193 kb)

Image 4.2

(Dropout left) Volume rendering of a bicuspid valve with rafe between the right and the non-coronary cusps seen from the aortic perspective. The fibrosis and calcification of the rafe create drop out artifacts in the thin non-coronary and left aortic cusps. (Dropout right) Volume rendering of the interatrial septum seen from the right atrial perspective. A hole, resembling an interatrial defect, appeared. However, no shunt was detected by color Doppler and saline contrast infusion (TIF 2207 kb)

Image 4.3

(Over gainGain) The data set has been acquired with too high gain Gain settings that will compromize the optimale rendering of the anatomy even after the Data processing thresholding thresholding occurring during postprocessing (TIF 2130 kb)

Image 4.4

(UndergainGain) The data set has been acquired with too low gain Gain settings and shows drop outs that cannot be compensated during postprocessing (TIF 2058 kb)

Image 4.5

Poor resolution (TIF 1694 kb)

Image 4.6

(Reverberations) Normofunctioning bileaflet mechanical valve in mitral position that appears with a stuck occluder due to reverberations of the anterior occluder which is positioned between the probe and the posterior one (TIF 1615 kb)

Image 4.7

(Near field clutter) The rounded artifact at the apex of the left ventricle may be erroneously interpreted as a mass (e.g. thrombus) (TIF 2454 kb)

Image 4.8

(Stationary) The image of the mass Left ventricular mass in the left ventricular outflow tract Left ventricular outflow tract (LVOT dose non follow the contraction and translational motion of the surrounding cardiac structures (TIF 1615 kb)

(Stitching) Multibeat Acquisition multi-beat full volume acquisition. Acquisition full volume Volume rendering of a mitral valve with clear separation of subvolumes due to several issues with the ECG trace: prominent P wave which is triggered together with the R wave; deep S wave triggered together with the R wave; ventricular ectopic beat (AVI 19083 kb)

(Dropout left) Volume rendering of a bicuspid valve with rafe between the right and the non-coronary cusps seen from the aortic perspective. The fibrosis and calcification of the rafe create drop out artifacts in the thin non-coronary and left aortic cusps (AVI 2172 kb)

(Dropout right) Volume rendering of the interatrial septum seen from the right atrial perspective. A hole, resembling an interatrial defect, appeared. However, no shunt was detected by color Doppler and saline contrast infusion (MOV 104 kb)

(OvergainGain The data set has been acquired with too high gain Gain settings that will compromize the optimale rendering of the anatomy even after the thresholding Data processing thresholding occurring during postprocessing (AVI 3683 kb)

(Under gain) The data set has been acquired with too low gain settings and shows drop outs that cannot be compensated during postprocessing (AVI 8888 kb)

(Reverberations) Normofunctioning bileaflet mechanical valve in mitral position that appears with a stuck occluder due to reverberations of the anterior occluder which is positioned between the probe and the posterior one (AVI 2707 kb)

(Near field clutter) The rounded artifact at the apex of the left ventricle may be erroneously interpreted as a mass (e.g. thrombus) (MOV 110 kb)

(Stationary) The image of the mass Left ventricular mass in the left ventricular outflow tract Left ventricular outflow tract (LVOT) dose non follow the contraction and translational motion of the surrounding cardiac structures (MOV 114 kb)

(Left Video) Volume rendering of a bicuspid aortic valve with rafe between the right and the non-coronary cusps obtained by cropping data sets acquired using the parasternal approach (AVI 15268 kb)

(Right Video) Volume rendering of the same bicuspid aortic valve with rafe between the right and the non-coronary cusps obtained by cropping data sets acquired using the apical approach. The resolution of this image is worse than the resolution of the image acquired from the parasternal approach (AVI 16904 kb)

(Too much gain) Gain The data set acquired with a little of overgain in order to avoid drop-out artifact Artifacts drop-out s (AVI 19111 kb)

(Optimal) Optimal thresholding allows the visualization of the mitral valve by removing the noise and choosing the proper depth color map (AVI 17259 kb)

(Too low gain) Gain Too much Much gain Gain reduction may create drop-out effects (AVI 16370 kb)

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Muraru, D., Badano, L.P. (2019). How to Implement Three-Dimensional Echocardiography in the Routine of the Echocardiography Laboratory. In: Badano, L., Lang, R., Muraru, D. (eds) Textbook of Three-Dimensional Echocardiography. Springer, Cham. https://doi.org/10.1007/978-3-030-14032-8_4

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