A new tool has been recently introduced to the echocardiography armamentarium, live/real time three-dimensional (3D) transesophageal echocardiography (TEE). In these cases, we describe our initial experience in 13 patients studied intraoperatively and in the echocardiography suite. This important technology promises improved anatomic definition, diagnostic confidence, and novel views of the complicated cardiovascular pathology encountered in common clinical practice.

Our preliminary study suggests that combined 2DTTE and 3DTTE has comparable accuracy to TEE in evaluating the LA and LAA for thrombus. In some patients TEE, but not 3DTTE, may misdiagnose pectinate musculature as thrombus.

We studied 31 patients with prosthetic valves (PVs) using two-dimensional and three-dimensional transthorathic echocardiography (2DTTE and 3DTTE, respectively) in order to determine whether 3DTTE provides an incremental value on top of 2DTTE in the evaluation of these patients. With 3DTTE both leaflets of the St. Jude mechanical PV can be visualized simultaneously, thereby increasing the diagnostic confidence in excluding valvular abnormalities and overcoming the well-known limitations of 2DTTE in the examination of PVs, which heavily relies on Doppler. Three-dimensional transthorathic echocardiography provides a more comprehensive evaluation of PV regurgitation than 2DTTE with its ability to more precisely quantify PV regurgitation, in determining the mechanism causing regurgitation, and in localizing the regurgitant defect. Furthermore, 3DTTE is superior in identifying, quantifying, and localizing PV thrombi and vegetations, in addition to the unique feature of providing a look inside mass lesions by serial sectioning. These preliminary results suggest the superiority of 3DTTE over 2DTTE in the evaluation of PVs and that it provides incremental knowledge to the echocardiographer.

Using two- (2DTTE) and three-dimensional transthoracic echocardiography (3DTTE) and an oral contrast agent (a carbonated beverage), a mass-like lesion behind the left ventricular posterior wall in an elderly female was definitively diagnosed as a hiatal hernia. A 3DTTE provided a more comprehensive evaluation of the hiatal hernia as compared to the 2DTTE in terms of its size and extent and thickness of the wall. The size of the hernia was underestimated by 2DTTE (3.3 x 3.2 cm) as compared to 3DTTE (at least 7 x 4.8 cm). The maximum thickness of the gastric wall was also found to be larger by 3DTTE (11 mm) as compared to 2DTTE (5 mm). Both the size of the hernia and thickness of the wall have important clinical implications. The size has been reported to be the strongest predictor of severity of esophagitis and gastric wall thickness of 10 mm or more has been associated with malignant or potentially malignant gastric lesions.

We describe echocardiographic findings in an elderly patient with histologically proven amorphous tumor involving the posterior mitral annulus, mimicking a vegetation.