Three-dimensional echocardiography in the clinical world
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1 Three-dimensional echocardiography in the clinical world Dr. JL Zamorano Director CV Institute University Clinic SC, Madrid
2 Advantages of 3D. Spatial manipulation. Optimal alineation of structures. Views and planes impossible to get in 2D. Single acquisition, multiple information. Easy approach to complex problems. Volumes calculation. No geometrical assumption (Right ventricle). Precision MRI, (but faster and cheaper).
3 J Am Coll Cardiol 2004;43:
4 Gorlin - RT3D Evaluation of Mitral valve area MVA estimated by: 2D Echo : PHT Planimetry PISA 3D Gorlin Conclusions: SD Mean SD AVERAGE of Gorlin and RT3D 3D RT is very accurate in assessing MVA 3D RT showed better agreement.
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6 MV pre post MVP Conclusion: 3D RT better correlation with Gorlin, after MVP
7 Mitral valve. Mitral stenosis. 3D: Best diagnostic tool for structural mitral evaluation. Anatomy of leaflets, comissures, subvalvular apparatus. Planimetry of oriffice: superior to 2D. Guide for balloon valvulotomy. Score. Oriffice post-valvuloplastia. Complications.
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9 Mitral valve. Mitral regurgitation. Circulation, March 2003 Mechanism of Mi regurgitation
10 Mitral valve. Mitral regurgitation. Volumes quantification. 3D colour doppler quantification: promising perspectives. Mechanism of Mi regurgitation.
11 Volumes. 2D echo?? 2D: Simpson Problems: Optimal alignement? Geometric asumptions
12 3D: Volumes calculation Quantification of left ventricular volumes and ejection fraction using freehand transthoracic three-dimensional echocardiography: comparison with magnetic resonance imaging. Mannaerts HF, Van Der Heide JA, Kamp O, Papavassiliu T, Marcus JT, Beek A, Van Rossum AC, Twisk J, Visser CA. JASE D underestimates volumes
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14 RT3D: Semiautomated border detection Improved semiautomated quantification of LV volumes and EF using 3D echocardiography with a full matrix-array transducer: comparison with magnetic resonance imaging. Caiani EG, Corsi C, Zamorano JL, Sugeng L, MacEneaney P, Weinert L, Battani R, Gutiérrez-Chico JL, Koch R, Pérez de Isla L, Mor-Avi V, Lang RM. JASE 2005 Aug
15 Volumes in 3D Volumes calculation Slice view Direct comparison with gold standard
16 Aortic area with RT 3D echo?
17 Aortic stenosis: Continuity equation Cumulative error in several parameters Depending on good parasternal & apical acoustic windows TSVI IVT TSVI D TSVI A Ao = π ( ) 2 IVT TSVI 2 IVT Ao
18 Aortic stenosis: Continuity equation Cumulative error in several parameters Depending on good parasternal & apical acoustic windows TSVI IVT TSVI D TSVI A Ao = π ( ) 2 IVT TSVI 2 IVT Ao STROKE VOLUME
19 Aortic stenosis: Continuity equation Cumulative error in several parameters Depending on good parasternal & apical acoustic windows TSVI IVT TSVI A Ao = SV IVT Ao STROKE VOLUME
20 Aortic area: RT3D-Doppler hybrid approach
21 Aortic area: Invasive: Gorlin Hakki Echo: Continuity equation Volumetric Simpson RT 3D
22 Leak closure. Echo info
23 Conclusions 3D is the best imaging for Mitral valve. New approach to mitral anatomy and mitral prolapse. 3D planimetry: Best non-invasive methode for Mi stenosis. Mechanism of Mi regurgitation. Best option for complex problems, MVP, surgical repair. 3D colour Doppler: promising perspectives for quantification of valvular regurgitations. MONITOR INTERVENTIONS Volume estimation similar to MRI
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