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Echocardiographic examinations

—Echocardiographic examinations

Transthoracic examination
TEE - views
Stress echocardiography
Contrast echocardiography
Cardiac asynchrony
Strain Imaging
3D | 4D echo
Indications for echocardiography
Training in echocardiography

—Cardiac function and PA pressure

—Examples of pathological

3D | 4D echocardiography

Guidelines and Standards
Recommendations for Image Acquisition and Display Using Three-Dimensional Echocardiography, 2012
Three-dimensional Echocardiography in Congenital Heart Disease, 2017

Until recently, none of the algorithms developed seemed suitable for routine examinations. However, the development of three-dimensional echocardiography made a big leap in recent years. Transthoracic and transesophageal echocardiography are currently able to provide 3D reconstructions, as well as a real-time rendering (4D) of the heart.

New 3D software and matrix array transducers allow rapid data acquisition and online or offline reconstruction of data with a satisfactory to good quality. 3D volumes and ejection fraction (EF) of the chamber can be calculated offline. However, a moderate to good ultrasound quality is necessary to guarantee a reliable reconstruction 3D/4D data.

As the road to full automation of echocardiographic examinations progresses, excellent knowledge of anatomy and physiology, as well as good spatial imagination and creativity are still required from the examiner. The following are examples of possible routine use of 3D/4D echocardiography.

Left: 3D volumetry of the LV. Depiction of an offline reconstruction in a normal LV function. The 3D-EF is here 73 %.

Right: the 3D-EF here in an ante- rior wall infarction with aneurysm formation is 38 %. These samples were kindly provided by Dr. med. Sebastian Buss.

Left: the 3D volumetry repre- sents an important step in the evaluation of the right ventricle (RV). Here a four-chamber view of a RV with a severy depressed function.

Right: an EF of 11 % could be a calculated using 3D volumetry.

The 3D/4D evaluation of heart valves, and especially of the mitral valve, is one of the highlights of 3D transesophageal echocardiography (3D-TEE).

Here is a standard depiction of the mitral valve during a TEE examination. A partial chordal rupture with a subsequent flail mitral valve leaflet on segment P2 can be observed (arrow).

The same case documented here by means of 4D-TEE. The partial chordal rupture is clearly visible (arrow).

At the current state of the art, "real time" 3D-TEE (4D-TEE) is not able to perform a complete depiction of cardiac structures. Only 1/3 of the available matrix crystals are used to enable a real-time 3D analysis (4D).

The same case, here after 3D reconstruction. Artifacts can arise during the data acquisition, e.g. respiration, atrial fibrillation, etc.

The image was rotated to the "surgical view". At 12 o'clock is the aortic valve. At 9 o'clock, the entrance to the left atrial appendage. Chordal rupture can be seen in the transition segments P2-P1 (arrow).

The depiction of cardiac masses is naturally an important task of 3D/4D echocardiography.

Here, an incidental finding of a mass with insertion at the mitral valve annulus, between the left atrial appendage and the mitral valve.

Also atherosclerotic plaques on the aortic wall, as seen here in the aortic arch, can be shown with 3D-TEE (arrow).

Also complex congenital heart defects can be well documented using 3D-TEE.

Here, an example of a L-trans- position of the great vessels. Aortic (A) and pulmonary valves (P), aorta and pulmonary artery have a parallel course, tricuspid valve (T) at the systemic ventricle, right atrium (RA), two electrodes can be seen in the superior vena cava and the RA (arrows).

Left: results of various therapeutic methods can be examined during follow-up using 3D. Here, an example of a severe mitral regurgitation

Right: treated with a percutan- eous "edge-to-edge" mitral valve reconstruction (percutaneous Al- fieri technique).

Left: mitral regurgitation appears significantly reduced after the procedure, compared to the 3D examination before treatment.

Right: the opening surface of the mitral valve after the Alfieri reconstruction (arrow) is reduced and resembles an 8.


© Derliz Mereles


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