Image orientation for three-dimensional echocardiography of congenital heart disease

Abstract

To date there has been little discussion about image orientation for three-dimensional (3D) echocardiography when applied to congenital heart lesions. Anatomic relations cannot be assumed in congenital heart disease and image cropping during post processing may by necessity remove external or even internal anatomic references. We present an approach to consistent anatomic orientation which is both intuitive and consistent with regard to superior-inferior, anterior-posterior and left-right axes. Such anatomic orientation is also concordant with other common 3D imaging modes such as cardiac magnetic resonance imaging and computed tomography. Views derived from standard cross sectional echocardiography have such universal familiarity that analogous 3D projections of these views may be retained but novel hitherto unavailable views such as en face views of the cardiac septums or atrioventricular valves may be projected using anatomic orientation.

Insights Gained From Three-Dimensional Imaging Modalities for Closure of Ventricular Septal Defects

“…12 The approach that has been adopted at our center and others is to present images in an anatomic format, particularly for views that are unique to 3DE such as en face visualization of septal structures and AV valves. 10 This approach is both intuitive and consistent with other imaging modalities, such as MRI and computed tomography. Anatomic presentation is readily achieved in postprocessing by appropriate rotation of rendered images.…”

“…Images are presented in an intuitive anatomic format, which is consistent with other cardiac imaging modalities, such as MRI and angiography. 10 …”

Congenital heart disease in children

“…The unique cropping planes facilitate en face presentation of atrioventricular valves, semilunar valves, and septal structures. Recent work has addressed the optimal orientation and presentation of 3D echocardiographic views [13] [14]. For imaging of septal structures such as the atrial septum and ventricular septum, there is a broad consensus as to the optimal mode of presentation.…”

“…For imaging of septal structures such as the atrial septum and ventricular septum, there is a broad consensus as to the optimal mode of presentation. With respect to the orientation of atrioventricular valves, there are some differences between the published references [13][14] with some of the congenital groups who have published on this subject favoring an anatomic projection. Differences in approach might be explained by the patient groups involved.…”

Four‐Dimensional Visualization of Accessory Mitral Valve Tissue and Cleft Mitral Valve Movement

“…When we investigate congenital heart disease, 3D echocardiography enables accurate analysis of the complex spatial anatomy. In particular, en face visualization of cleft mitral valve and accessory mitral valve cannot be obtained by 2D echocardiography …”