胎儿三维超声心动图在胸腹联胎产前诊断中的体会

目的：探讨胎儿实时三维超声心动图（RT-3DE）在胸腹联胎产前诊断中的影像学特征。方法：选取我院2014.1-2015.1经产前超声筛拣出的对称性胸腹联胎5例,行胎儿二维超声心动图（2DE）及胎儿实时三维超声心动图检测。RT-3DE选择3D cropping、xPlane任意平面成像及3D-Beats模式,多切面多方位多角度观察胎儿心脏。结果：5例对称性胸腹联胎均有两个心包,两套心血管系统,其中一个心脏结构正常,另一个为单流入型单心室合并单心房或其他类型非紫绀型先天性心脏病。染色体检测多无异常。结论：对称性胸腹联胎胎儿超声心动图超声表现具有特征性,胎儿实时三维超声心动图是联体双胎产前超声诊断的良好补充。     

实时三维超声心动图的临床应用及研究进展

实时三维超声心动图技术是超声成像领域内一项重大的技术性突破。它不仅能够精确、可靠的评价心功能的定性及定量参数,而且对于瓣膜结构、先天性心脏病各种畸形提供新的图像视角。可使临床医师方便、立体、准确、实时的观察心脏的解剖结构和功能。实时三维超声心动图必定在各类心脏疾病的诊断、治疗及预后评估方面起到越来越重要的作用。现就三维超声成像原理、临床应用、研究进展予以综述。     

Imaging modalities in valvular heart disease

Evaluating valvular heart disease requires a multi-parametric analysis of valvular pathology, hemodynamic derangements, and impact on ventricular size and function. The capability to perform real-time three-dimensional (3-D) imaging has vastly strengthened the already established role of echocardiography. CT and MRI advances have led to their use as daily clinical tools. Two-dimensional and 3-D echocardiography and Doppler modalities allow for accurate assessment of valvular lesions, pressure gradients, stenotic valve orifice areas, pulmonary artery pressures, intracardiac pressures, and regurgitant volumes. Quantitation of chamber volumes has become more accurate and reproducible with 3-D echocardiography, CT, and cardiac MRI. Although ultrasound imaging is the primary tool, the other techniques provide adjuvant or alternate options to examine valvular heart disease. This array of imaging modalities is likely to provide greater insights into the pathophysiology of valvular heart disease, new pointers to prognosis, and also guide innovative treatment strategies.     

Pränatale Herzdiagnostik mittels zwei- und dreidimensionaler Fetalechokardiographie

INTRODUCTION: With increasing experience of obstetric sonographers, a higher proportion of cardiac malformations is found antenatally. However, undiagnosed fetal cardiac defects still result in a significant pre- and postnatal morbidity and mortality. The purpose of two- and three-dimensional echocardiographic imaging in the fetus is to provide clear representations of the underlying cardiac and vascular anatomy. Studies on pre- and postnatal echocardiography have shown these techniques to provide an adequate form of image display for comprehensive assessment of most cases with congenital heart disease. METHODS: To date, two different methods are used for three-dimensional echocardiography in the fetus. The technique currently employed at numerous institutions derives from a complex assembly of sequentially acquired and reconstructed two-dimensional images and is analogous to the 3-D technology assessed in studies on neonates, children, and adults. Although an electromagnetic location device is used to register transducer position during data acquisition, this technique has important limitations due to fetal movement artifacts and difficulties in cardiac gating. This often results in inadequate image quality when compared with 2-D echocardiography. Recent progress in the design and fabrication of higher-frequency real-time volumetric transducers has greatly improved 3-D echocardiographic imaging resolution and allows more immediate three-dimensional "on-line" analysis of cardiac anatomy. CONCLUSIONS: Advantages of 3-D fetal echocardiography include the ability to slice the acquired 3-D volume data into an infinite number of two-dimensional cross sections, and the ability to reconstruct unique three-dimensional views not seen with two-dimensional imaging. However, considering the current limitations and the time needed for 3-D image processing, its practical clinical relevance in the antenatal situation is not yet clear.     

Real-time 3-dimensional echocardiography. Technique and clinical applications

This article will provide an overview of real time 3-dimensional (3D) echocardiography (RT-3D) in evaluation of patients with heart disease. We will briefly describe the technique and our experience in its clinical applications in patients with coronary artery disease, left ventricular apical thrombi, mitral stenosis and its role in guiding intracardiac catheter placement. Our extensive experience with application of RT-3D during dobutamine stress and during supine bicycle exercise indicates the technique is sensitive in detection of ischemia. RT-3D has been valuable in clearly identifying left ventricular apical thrombi in patients in whom 2-dimensional (2D) echo cannot firmly establish their presence or absence. We have utilized RT-3D in guiding myocardial biopsy in heart transplant patients and in precisely measuring mitral valve area before and after balloon valvuloplasty. RT-3D technique continues to evolve and should play an important role in assessment of patients with heart disease.     

Real-time three-dimensional dobutamine stress echocardiography in assessment stress echocardiography in assessment of ischemia: comparison with two-dimensional dobutamine stress echocardiography

OBJECTIVES: This study was designed to test the feasibility and efficacy of using real-time three-dimensional echocardiography (RT-3D) to detect ischemia during dobutamine-induced stress (DSE) and compares the results with conventional two-dimensional echocardiography (2D). BACKGROUND: Real-time three-dimensional echocardiography, a novel imaging technique, offers rapid acquisition with multiple simultaneous views of the left ventricle (LV). These features make it attractive for application during stress. METHODS: Of 279 consecutive patients screened for image quality by 2D, 253 patients with adequate images underwent RT-3D and 2D within 30 s of each other at baseline and at peak DSE. RESULTS: Real-time three-dimensional echocardiography and 2D showed good concordance in detection of abnormal LV wall motion at baseline (84%: Kappa = 0.59) and at peak DSE (88.9%: Kappa = 0.72). Left ventricular wall motion scores were similar at baseline and peak DSE using both techniques. Interobserver agreements for detection of ischemia at peak DSE were superior for RT-3D, 92.7% compared with 84.6% for 2D (p < 0.05). Mean scanning time at peak stress by RT-3D in 50 randomly selected patients was shorter, 27.4 +/- 10.7 s compared with 62.4 +/- 20.1 s by 2D (p < 0.0001). In 90 patients with coronary angiograms, RT-3D had a sensitivity of 87.9% in the detection of coronary artery disease (CAD) compared with 79.3% by 2D. CONCLUSIONS: Real-time three-dimensional dobutamine stress echocardiography is feasible and sensitive in the detection of CAD. The procedure offers shorter scanning time, superior interobserver agreements and unique new views of the LV.     

实时三维超声心动图与临床

实时三维超声成像是心脏超声发展的重大飞跃,可为心血管疾病的准确诊断提供更多的有用信息。实时三维超声无论在定性和定量两个方面都对临床诊断具有重要作用。现就实时三维超声心动图在心脏瓣膜、先天性心脏病、心脏占位、心肌病、主动脉夹层、左室室壁瘤、Bental术后人造血管吻合口漏、左心功能评价等方面的临床价值做一综述。     

负荷超声心动图在缺血性心脏病中的临床应用进展

近年来,随着缺血性心脏病发病率的逐年升高,无创评估影像技术越来越受到人们关注。负荷超声心动图作为一项较成熟的技术,目前已用于缺血性心脏病的诊断、存活心肌的评价、危险分层和预后的评估。心肌声学造影、斑点追踪成像技术和三维超声心动图等超声新技术的发展,使负荷超声心动图的诊断准确性和特异性均有提升,相信未来会更广泛地应用于临床。     

Imaging the pericardium

Noninvasive imaging has profoundly altered our ability to diagnose and manage patients with suspected pericardial disease. Although pericardial involvement may first become apparent on a chest radiography, echocardiography (M-mode, 2-D, and Doppler) is the procedure of choice for identifying and characterizing pericardial disease. CT and MRI frequently provide complementary information and in certain instances are necessary for diagnosis. Studies that compare diagnostic accuracy in subsets of patients with pericardial disease are clearly needed, but availability, safety, and cost considerations will influence the choice of procedure. Regardless of the imaging study selected, it is imperative that the results be interpreted in the context of the clinical examination.     

Real-time three-dimensional echocardiography for improved evaluation of diastolic function using volume-time curves

BACKGROUND: Accurate assessment of left ventricular function is of the greatest importance in clinical cardiology for decision making. Diastolic dysfunction is getting more concern as a cause of heart failure while, currently used non-invasive modalities for diagnosing diastolic abnormalities have significant limitations. Dynamic left ventricular volume change was applied for the evaluation of diastolic function by various techniques that have been demonstrated to be of diagnostic value. However, it has not been accepted into clinical practice because existing techniques are either invasive, inaccurate, expensive or time consuming. REAL-TIME THREE-DIMENSIONAL ECHOCARDIOGRAPHY: Real-time three-dimensional (3-D) echocardiography is a new ultrasound technique that provides transthoracic volumetric images of the heart in real time. Thereby, the acquired images are ideally suited for the assessment of dynamic left ventricular volume change. Generation and analysis of left ventricular volume-time curves by real-time 3-D echocardiography has been demonstrated to be feasible in normal subjects and patients and accuracy of volume-time curves was good compared to magnetic resonance imaging. We compare the new real-time 3-D echo approach with the advantages and limitations of existing noninvasive and invasive techniques.     

实时三维超声心动图评价不同病因心力衰竭患者左心室收缩同步性的价值

目的探讨实时三维超声心动图（real-time three-dimensional echocardiography,RT-3DE）在评价心力衰竭患者左心室收缩同步性方面的应用价值。方法分别应用组织多普勒显像（tissue Doppler image,TDI）技术及RT-3DE对44例慢性心力衰竭患者（24例扩张型心肌病,20例缺血性心肌病）进行左心室收缩同步性分析,比较两种方法对不同病因心力衰竭患者左心室收缩同步性的评价结果,分析结果的一致性。结果TDI在24例扩张型心肌病患者中检出15例左心室收缩不同步,RT-3DE检出16例,TDI与RT-3DE均判定为左心室收缩不同步的患者有14例,Kappa值为0.727,P〈0.01;TDI在20例缺血性心肌病患者中检出8例左心室收缩不同步,RT-3DE检出13例,TDI与RT-3DE均判定为左心室收缩不同步有6例,Kappa值为0.151,P〉0.05。结论评价扩张型心肌病患者的左心室收缩同步性TDI与RT-3DE的一致性较好,评价缺血性心肌病患者的左心室收缩同步性两者一致性差。     

Adolescent and adult congenital heart disease assessed by real-time three-dimensional echocardiography: an initial experience.

Real-time three-dimensional (3D) echocardiography has enormous diagnostic potential, enabling acquisition of full-volume three-dimensional images in real time, which can be sliced in several planes and rotated in order to achieve a more accurate study of the target cardiac structures. It is particularly useful because it enables the heart to be visualized from multiple perspectives in the same way a surgeon would see it during an operation. We describe our echocardiographic laboratory's experience with real-time 3D ultrasound study of adolescent and adult congenital heart disease.     

实时三维超声心动图评估心肌重量的研究

实时三维超声心动图(RT-3DE)是新近发展起来的技术,较M型超声、二维超声心动图及传统的重建三维更快速地获得直观精确的定量信息,RT-3DE测量心肌重量对心血管疾病诊断、治疗及预后有重要意义。     

Partial atrioventricular septal defect assessed by real-time three-dimensional echocardiography: a case report

A 48-year-old woman was admitted with a heart murmur and increased difficulty in breathing. Two-dimensional echocardiography revealed a defect in the lower part of the atrial septum [(primum atrial septal defect (ASD)] and a pouch at the interventricular septum. Color Doppler echocardiography detected grade 3/4 mitral regurgitation. Real-time three-dimensional echocardiography (RT-3DE) revealed a cleft in the anterior leaflet of the mitral valve toward the tricuspid valve, and the ASD located near the atrioventricular valves with 14mm in minor axis. Color Doppler three-dimensional echocardiography disclosed left-to-right ASD shunt toward the atrial posterior wall. No shunt through the pouch at the membranous part, left ventricular outflow obstruction, or partial anomalous pulmonary venous connection was observed. RT-3DE is quite useful to describe complicated congenital heart disease.     

3-D echocardiography: new developments and future prospects

Due to limitations in transthoracic and occasionally transesophageal 2-D echocardiography with respect to volumetric analysis and morphologic and functional assessment in patients with congenital malformations and valvular heart disease, additional diagnostic tools have been established. In parallel with the rapid evolution in computer technology, 3-D echocardiography has grown into a well-developed technique, such as volume-rendered 3-D reconstruction, capable of displaying dynamic morphology depicting depth of the structures, their attachment, and spatial relation to the surrounding tissue. Nevertheless, the complexity of data acquisition and data processing required for adequate dynamic 3-D echocardiographic imaging and volumetric analysis does not allow to use this approach routinely. The commonly used dynamic 3-D echocardiography means off-line computer-assisted image reconstruction from a series of cross-sectional echocardiographic images using currently available transesophageal and transthoracic transducers. Alternatively, real-time 3-D echocardiography based on novel matrix, phased-array transducer technology has been introduced. Although this technique can be easily combined with any routine examination, its clinical use is limited because of a lower image quality in comparison with dynamic 3-D echocardiography. Up to now, there is no transesophageal approach available using real-time 3-D echocardiography. Recently, dynamic 3-D echocardiographic technique has matured noticeably. Beside the well-known sequential scanning, which is characterized by a fixed probe and patient in space and predetermined motion of the transducer, the freehand scanning using an electromagnetic location system has found its way to clinical environment. The main advantage of this technique is that the transducer can be freely moved by the examiner and, thus, the data set acquired within a routine examination. Also 3-D rendering and display have been developed further. In this respect, especially the "real-time rendering mode" allowing the reconstructed 3-D image to be animated and moved in space and to look at it from different perspectives has gained increasing acceptance. In valvular heart disease, reconstructive surgical treatment is aspired. 3-D echocardiographic imaging is the only technique providing "surgical views" prior to opening the heart. It is capable of distinguishing particular destructive substructures of the valves and the valvular apparatus. Especially in mitral valvular reconstruction, it is of clinical importance to achieve optimal surgical results. With respect to volumetric and mass analysis, 3-D echocardiography is more accurate and reproducible in comparison with conventional 2-D analysis. It provides data independent of geometric assumptions, what may considerably influence the results in the presence of wall motion abnormalities, especially in aneurysmatic ventricles. Volumetric analysis of the aneurysmal portion may also be helpful prior to surgical resection. 3-D echocardiography can also be recommended as a valuable additional approach to atrial septal defect (ASD), corrected transposition of the great arteries, cor triatriatum, and, within limits, to ventricular septal defect (VSD) as well. Especially with respect to ASD and VSD, the potential significance of 3-D echocardiography prior to device closure is emphasized. At present, its additional information in decision-making and the increasing number of clinical cases that can be addressed and answered already justify the clinical use of this technique.     

Real time three-dimensional echocardiography in assessing ventricular septal defects: an echocardiographic-surgical correlative study

BACKGROUND: Two-dimensional echocardiography (2DE) enhanced by combining with color Doppler technology has significant limitations in providing precise quantitative information, geometric assumptions to calculate chamber volume, mass, and ejection fraction. Reconstructed three-dimensional echocardiographic (3DE) systems (from multiple cross-sectional echocardiographic scans) are still cumbersome and time-consuming. Real time 3DE (RT-3DE) with shorter imaging time than with 3D reconstruction techniques can obtain qualitative and quantitative information on heart disorders. Our purpose was to investigate the feasibility and potential value of RT-3DE as a means of accurately and quantitatively estimating the size of VSD to correlate with the surgical findings. MATERIALS AND METHODS: 38 patients with VSD were examined with RT-3DE. 3D image database was postprocessed using TomTec echo 3D workstation. The results were compared with the results measured by 2 DE and surgical findings. RT-3DE produced novel views of VSD and improved quantification of the size of the defect. The sizes obtained from 3DE have equivalent correlation with surgical findings as diameter measured by 2DE (r = 0.89 vs r = 0.90). Good agreement between blinded observers was achieved by little interobserver variability. CONCLUSION: RT-3DE offers intraoperative visualization of VSD to generate a "virtual sense of depth" without extending examining time. From an LV en face projection, the positions, sizes, and shapes of VSDs can be accurately determined to permit quantitative recording of VSD dynamics. It is a potentially valuable clinical tool to provide precise imaging for surgical and catheter-based closure of difficult perimembranous and singular or multiple muscular VSD.     

Transthoracic real-time three-dimensional echocardiography in the diagnosis and description of noncompaction of ventricular myocardium

BACKGROUND: Numerous modalities have been used to diagnose and characterize noncompaction of ventricular myocardium (NCVM) including magnetic resonance imaging, two-dimensional echocardiography (2DE), contrast-enhanced 2DE, and angiography. The current case series examines the use of real-time three-dimensional transthoracic echocardiography (RT-3DE) in four such cases of NCVM. METHODS: From December 2003 to March 2004, we performed RT-3DE using a Philips Sonos 7500 echocardiographic scanner equipped with a 2-4 MHz 3D matrix array transthoracic probe, to evaluate four patients with NCVM. The real-time 3D transthoracic probe allows for dataset acquisition in an ultrasound wedge, which can be manipulated instantaneously. In addition, complete 3D volume rendering is acquired, allowing for volumetric imaging. RESULTS: The age range of the patients was 2 months to 42 years. One patient had the codiagnoses of coarctation of the aorta and bicuspid aortic valve. In all four patients, RT-3DE enabled diagnosis and provided detailed characterization of the affected myocardium. Entire trabecular projections and intertrabecular recesses were easily visualized simultaneously, and endocardial borders were clearly demarcated. Wall motion abnormalities of the affected myocardium were clearly visualized. The compacted and noncompacted portions of the myocardium could be differentiated well. CONCLUSIONS: Our study provides preliminary data highlighting the utility and feasibility of RT-3DE in the clinical characterization of NCVM. The complex 3D nature of this disorder and the endocardial hypertrabeculation were more readily visualized than with 2DE.     

Real time three-dimensional transthoracic echocardiography in congenital heart disease

Diagnosing congenital heart disease (CHD) depends heavily on imaging. Traditionally, two-dimensional (2D) echocardiography has been the most widely used but since this imaging modality utilizes a 2D technique to evaluate three-dimensional (3D) structures it suffers from inherent limitations. The more recently developed 3D echocardiography is poised to be superior in providing comprehensive evaluation prior to intervention on such complex conditions. In this review, we summarize the applications of 3D echocardiography in evaluating patients with CHD.     

实时三维超声评价先天性心脏病合并肺动脉高压患者的左心功能及同步性研究

目的:应用实时三维超声及二尖瓣环组织多普勒成像技术评价先天性心脏病(先心病)合并肺动脉高压(PAH)患者的左心功能。方法:对12例先心病合并重度PAH患者及正常组12例分别进行二维及三维超声心动图检查,实时三维测量左心室舒张末期容积和收缩末期容积。应用QLAB软件技术描绘左心室容量-时间曲线,计算左心室16节段达最低收缩末容量时间的标准差、最大差异及2者的标准化值。结果:结果显示其左心室容量-时间曲线各节段排列有序,起伏一致。与正常组相比,达最低收缩末容量的时间点几乎在同一条直线,差异无统计学意义。2组左心室射血分数差异无统计学意义。二尖瓣环组织速度成像显示:2组间舒张期二尖瓣环运动速度指标的比较可见重度肺动脉高压患者舒张早期运动速度(Ve)较正常组减低,舒张晚期速度(Va)增高。结论:实时三维超声心动图及组织多普勒技术能够比较准确综合评价先心病合并重度PAH患者的左心功能,实时三维超声心动图左心室容量-时间曲线形态及参数能全面反映PAH患者左心室运动同步性及功能变化。     

3-D echocardiographic imaging of double aortic arch.

Delineation of arch abnormalities is difficult by conventional 2-D echocardiography and MRI has been the investigation of choice. 3-D echocardiography is increasingly used in congenital heart disease for both functional anatomy and morphology. This case report demonstrates that 3-D echocardiography can be used in delineating arch anomalies, which can avoid further imaging that needs a general anaesthetic.