Article

PDF
Access to the PDF text
Advertising



Archives of cardiovascular diseases
Volume 104, n° 1
pages 45-56 (janvier 2011)
Doi : 10.1016/j.acvd.2010.11.004
Received : 18 October 2010 ;  accepted : 16 November 2010
Three-dimensional echocardiography in congenital heart disease
Échographie tridimensionnelle dans les cardiopathies congénitales
 

Figure 1




Figure 1 : 

Three-dimensional echocardiogram of a secundum atrial septal defect. This image was obtained using a rotational transoesophageal echocardiography system. The resulting image is a composite of cross-sectional images acquired over 2minutes as the probe angle rotated. Note the radial artefacts, which are due to the rotational acquisition. Ant: anterior; Ao: aorta; ASD: atrial septal defect; Inf: inferior; Post: posterior; Sup: superior; SVC: superior vena cava; TV: tricuspid valve.


Figure 2




Figure 2 : 

A. Transthoracic 3D echocardiographic image of the left atrioventricular valve in a patient with an atrioventricular septal defect. The valve is viewed en face from the ventricular aspect in an anatomical fashion so that superior structures are viewed uppermost on the image. B. Left atrioventricular valve viewed from the atrial aspect. Optimal anatomical orientation is obtained by rotation of the 3D dataset and cropping away intervening atrial structures. C. Transoesophageal 3D echocardiographic image of the anatomy of the atrioventricular septal defect viewed from the right atrial aspect. The atrial component of the defect has atrial margins marked by the arrow heads (>). The ventricular margin is marked by asterisks (*). The 3D technique permits this projection of the defect, which cannot be achieved by cross-sectional echocardiography. D. Transoesophageal 3D echocardiographic image of the atrioventricular septal defect viewed from the left atrial aspect. The atrial component of the defect has atrial margins marked by the arrow heads (>). The ventricular margin is marked by asterisks (*). The 3D technique shows clearly the underlying morphology. The relationship of the left ventricular outflow tract to the defect is shown particularly clearly. E. Atrioventricular septal defect following surgical repair. This is a transthoracic 3D image with the left atrioventricular valve viewed from the ventricular aspect. The sutured “cleft” (*) between the superior bridging leaflet and the inferior bridging leaflet can be clearly visualized as well as the triangular shaped mural leaflet. The ventricular septum is indictated by the arrow heads (>). Ant: anterior; AoV: aortic valve; CS: coronary sinus; FO: foramen ovale; IBL: inferior bridging leaflet; Inf: inferior; L: left; LAVV: left atrioventricular valve; LV: left ventricle; PA: pulmonary artery; Post: posterior; R: right; RAVV: right atrioventricular valve; RV: right ventricle; SBL: superior bridging leaflet; Sup: superior; SVC: superior vena cava.


Figure 3




Figure 3 : 

A. Transthoracic apical four-chamber view of Ebstein’s anomaly of the tricuspid valve. The plane of the normal tricuspid valve annulus is shown by the white line. A septal occluder has been used to close an atrial septal defect. B. The abnormal attachments of the tricuspid valve into the right ventricular outflow tract can be readily demonstrated. The image shows a view from the right atrial/right ventricular side to show the septal occluder en face. The normal plane of the tricuspid valve is indicated by the solid white line. The displacement of the septal leaflets of the tricuspid valve are shown by the asterisks (*) and the chordal attachments into the right ventricular outflow tract are shown by the arrow heads (<). LV: left ventricle; MV: mitral valve; PV: pulmonary valve; RA: right atrium; RV: right ventricle; TV: tricuspid valve; *: insertion of septal leaflet of the tricuspid valve; <: abnormal chordal insertion into the right ventricular outflow tract.


Figure 4




Figure 4 : 

A. 3D transoesophageal echocardiogram of an atrial septal defect. The atrial septum is viewed en face from the atrial septum. Note the anatomical orientation with more superior structures presented uppermost on the projected image. B. 3D transoesophageal echocardiogram demonstrating a fenestrated atrial septal defect viewed from the right atrial aspect. For optimal closure it is preferred to introduce the catheter across the major fenestration rather than a small fenestration. The anatomy of the atrial septal defect is clearly defined. C. 3D transoesophageal echocardiographic image of the catheter crossing the large fenestration in the atrial septal defect when viewed from the right atrial aspect. This is the same case as that in Figure 8a. The ability to visualize the exact path by which the catheter has crossed the atrial septum is a major strength of the technique. D. Deployment of atrial septal occluder under 3D echocardiographic guidance. This technique permits visualization of the plane of the atrial septum (marked by *), the catheter delivery system and the septal occluder. The targeted rendered 3D technique permits a depth of field to avoid structures passing out of plane. Ant: anterior; Ao: aorta; ASD: atrial septal defect; Inf: inferior; IVC: inferior vena cava; L: left; LA: left atrium; Post: posterior; R: right; RA: right atrium; RV: right ventricle; Sup: superior; SVC: superior vena cava; TV: tricuspid valve; *: atrial septum.


Figure 5




Figure 5 : 

A. Transthoracic 3D echocardiographic view of a slit-shaped muscular ventricular septal defect in an infant. The ventricular septal defect is viewed from the right ventricular aspect as if the right atrial wall and RV free wall are removed. The RV apex is to the right showing the superoinferiorly directed slit-like ventricular septal defect. The asterisks (*) mark the inferior, diaphragmatic surface of the heart. B. 3D transoesophageal echocardiographic guidance of closure of a muscular ventricular septal defect. The cardiac catheter can be traced accurately across the ventricular septum without the catheter falling out of the plane of the ultrasound beam. C. 3D transoesophageal echocardiographic image of device occlusion of a muscular ventricular septal defect. The left ventricular disc has been deployed but is still attached to the device delivery system, which may be seen crossing the ventricular septum. The depth of field permits a visualization of the device, delivery system and the relationship to the ventricular septal defect. Ant: anterior; Inf: inferior; LA: left atrium; LV: left ventricle; Post: posterior; RA: right atrium; RV: right ventricle; RVOT: right ventricular outflow tract; Sup: superior; TV: tricuspid valve; VSD: ventricular septal defect; >: ventricular septum.


Figure 6




Figure 6 : 

3D echocardiography of DORV. DORV is a lesion for which an understanding of the precise morphology is essential to plan surgical intervention. This can be achieved by interrogation of the volumetric dataset using multiplanar reformatted images and rendered 3D images. A. Multiplanar reformatted images from a patient with DORV. This technique permits interrogation of the echocardiographic dataset in any user defined planes. It is particularly helpful to “step through” the anatomy in complex morphologies. B. Rendered 3D echocardiogram projected form the ventricular aspect. This projection demonstrates the anatomy of a patient with DORV visualized from the ventricular apex. The relationship of the left ventricle, ventricular septum (arrow heads, <) and the great arteries is depicted in a single projection. To assist orientation, the image is rotated to bring the diaphragmatic surface of the heart (marked by *) into its true anatomical position. C. Projection of DORV visualized from the right ventricle. In this projection, the free wall of the right atrium, and the right ventricle, have been cropped away. The anatomy is viewed from the right ventricular aspect to demonstrate the relationship of the tricuspid valve, the ventricular septal defect and the great arteries. This may assist in selection of the optimal mode of repair. For reference, the inferior, diaphragmatic surface of the heart is marked by asterisks (*). D. Cropped view from the ventricular apex of the heart in DORV. This projection has been cropped close to the base of the heart to demonstrate the relationship between the mitral valve, tricuspid valve, VSD, aorta and pulmonary artery. In this example, the arrow shows that a route from the left ventricle to the aorta exists without impinging on the tricuspid valve or pulmonary valve. This patient had full repair by baffling from the left ventricle to the aorta through the VSD. Ao: aorta; AoV: aortic valve; DORV: double outlet right ventricle; Inf: inferior; L: left; LV: left ventricle; MV: mitral valve; PA: pulmonary artery; R: right; RV: right ventricle; Sup: superior; TV: tricuspid valve; VSD: ventricular septal defect; <: ventricular septum.


Figure 7




Figure 7 : 

A. 3D echocardiography of the left ventricle. A. The 3D outline of the right ventricle is shown in the upper right portion of the image. The colour-coded segments are demonstrated. In the lower section, the volume subtended by each of the cardiac segments throughout the cardiac cycle is illustrated. The time at which each segment reaches minimum volume is shown by the red triangles. The top left shows the systolic dyssynchrony index using 16, 12 or 6 cardiac segments. B. This figure shows the 17 segments of the left ventricle in a standardized “bull’s eye” format. The upper part of the figure shows the timing of each segment to reach minimum systolic volume and the lower part represents the excursion of each segment. Thus, the technique facilitates recognition of segments that are abnormal with respect to timing, amount and direction of endocardial motion. This example is from a normal child showing normal synchronous findings.


Figure 8




Figure 8 : 

Three-dimensional echocardiographic assessment of the right ventricle. Planimetry of the contours of the right ventricle in a multiplanar reformatted view permits generation of a 3D representation of the right ventricle. This computes the right ventricular end-diastolic volume, end-systolic volume and ejection fraction. The grey regions on the model represent the tricuspid valve and pulmonary valve. PA: pulmonary artery; TV: tricuspid valve.


Figure 9




Figure 9 : 

3D wall tracking in a patient with operated tetralogy of Fallot. In this example, a 3D volumetric dataset has been obtained incorporating the entire right ventricle. The 3D speckle-tracking algorithm follows speckles through the volumetric dataset. The colour coding represents 3D strain. The four-chamber, sagittal and short-axis cuts demonstrated are user-defined. The 3D strain model is shown in the lower-right pane. RA: right atrium; RV: right ventricle.

EM-CONSULTE.COM is registrered at the CNIL, déclaration n° 1286925.
As per the Law relating to information storage and personal integrity, you have the right to oppose (art 26 of that law), access (art 34 of that law) and rectify (art 36 of that law) your personal data. You may thus request that your data, should it be inaccurate, incomplete, unclear, outdated, not be used or stored, be corrected, clarified, updated or deleted.
Personal information regarding our website's visitors, including their identity, is confidential.
The owners of this website hereby guarantee to respect the legal confidentiality conditions, applicable in France, and not to disclose this data to third parties.
Close
Article Outline