Pericardial Three-dimensional Echocardiography

Abstract

Background. Transthoracic real-time 3-dimensional echocardiography (3DE) is useful for understanding anatomical structure in planning surgical procedures for treatment of congenital heart disease, but the image resolution has not reached a level that is sufficient to show the detailed anatomy required by surgeons, due to limitations in the width of the acoustic window and ultrasonic penetration. To improve the image quality, we applied the transpericardial approach to obtain the 3DE images and compared these images to those of the surgical findings.Methods. The study included 22 consecutive patients with congenital heart disease who underwent various surgical procedures and were imaged with transpericardial 3DE just before surgery, using a Philips iE33 system with an X3-1 probe (10 cases) or an X7-2 probe (12 cases)(Philips Medical Systems Inc. Andover, MA, USA). The 3D anatomical echocardiographic images were acquired by a pericardial approach and reconstructed using an off-line computer system (QLAB, Philips Med. Inc. Andover, MA, USA). Then these reconstructed 3DE images were compared to the intraoperative findings and the pictures taken during the operation.Results. Moving 3D images in a cardiac cycle were successfully reconstructed in all cases within 10 minutes. All intracardiac anatomy identified in each 3DE image corresponded to those seen in direct observation of the intracardiac structure. In one case with a double outlet right ventricle with subpulmonary ventricular septal defect (VSD), precise delineation of the spatial relationship between the great arteries and a VSD enabled simulation of the surgical procedure for placement of a patch to close the VSD.Conclusions. Transpericardial 3DE is a powerful diagnostic method to yield high quality real-time images equivalent enough to the surgical findings. (J Echocardiogr 2008; 6: 39-45)

Real-Time Three-Dimensional (3D) Echocardiography for Diagnosis and Treatment of Congenital Heart Diseases in Practical Medicine: Transepicardial and Transesophageal Approach

“…Although transthoracic 3D echocardiography has a certain level of diagnostic accuracy, we perform intraoperative transpericardial 3D echography with the aim to construct the good quality of images that would have more diagnostic accuracy and would be helpful for surgery [3]. In adult patients having severe mitral regurgitation, it is difficult to perform the detailed guide for mitral valvuloplasty by using transthoracic 3D echocardiography, while the transesophageal 3D echocardiography is better than that.…”

“…In addition, the chorda tendinea of the tricuspid valve appears to cross over the defect, which can be clearly confirmed by the 3D echocardiography. To close the defect, it used to be necessary to make a resection avoiding the chorda tendinea [3]. In the assessment of the double-outlet right ventricle and the VSD that is porous and more complicated, the positional relationship among the pulmonary valve, the aortic valve, the tricuspid valve, and the abnormal chorda tendinea in addition to the size or the number becomes even more important in order to determine the method of closing the defect and forming the intracardiac route.…”