Live/real time three-dimensional transthoracic echocardiographic assessment of aortic dissection rupture into right ventricular outflow tract: a case report and review of the literature.

We present a case of chronic ascending thoracic aortic dissection with rupture into the right ventricular outflow tract (RVOT) diagnosed by two-dimensional transthoracic echocardiogram in which live/real time three-dimensional (3D) transthoracic echocardiogram provided incremental value by demonstrating: (a) a tortuous false lumen that encroached and ruptured into the RVOT, (b) exact location of the rupture site in relation to other surrounding structures in 3 dimensions (c) en face view of the rupture site facilitating assessment of its size and shape, and (d) localized compression of the main pulmonary artery (PA) by the false lumen. In addition, cropping of the 3D data set permitted visualization of the origin of the left main coronary in a rapid manner excluding involvement of this vessel with the dissection process. These findings have potential implications for surgical planning and were corroborated by a computed tomography angiogram. We summarize seven previously reported aortic dissection cases with rupture into the right ventricle.

Incremental value of live/real time three-dimensional transthoracic echocardiography in the assessment of right ventricular masses.

This case series demonstrates the incremental value of three-dimensional transthoracic echocardiography (3D TTE) over two-dimensional transthoracic echocardiography (2D TTE) in the assessment of 11 patients with right ventricular (RV) masses or mass-like lesions (three cases of RV thrombus, one myxoma, one fibroma, one lipoma, one chordoma, and one sarcoma and three cases of RV noncompaction, which are considered to be mass-like in nature). 3D TTE was of incremental value in the assessment of these masses in that 3D TTE has the capacity to section the mass and view it from multiple angles, giving the examiner a more comprehensive assessment of the mass. This was particularly helpful in the cases of thrombi, as the presence of echolucencies indicated clot lysis. In addition, certainty in the number of thrombi present was an advantage of 3D TTE. Also, sectioning of cardiac tumors allowed more confidence in narrowing the differential diagnosis of the etiology of the mass. In addition, 3D TTE allowed us to identify precise location of the attachments of the masses as well as to determine whether there were mobile components to the mass. Another noteworthy advantage of 3D TTE was that the volumes of the masses could be calculated. Additionally, the findings by 3D TTE correlated well with pathologic examination of RV tumors, and some of the masses measured larger by 3D TTE than by 2D TTE, which was also validated in one case by surgery. As in the case of RV fibroma, another advantage was that 3D TTE actually identified more masses than 2D TTE. RV noncompaction was also well studied, and the assessment with 3D TTE helped to give a more definitive diagnosis in these patients.

Erroneous diagnosis of significant obstruction by Doppler in a patient with discrete subaortic membrane: correct diagnosis by 3D-transthoracic echocardiography.

We report an adult with a discrete subaortic membrane in whom two-dimensional transthoracic Doppler echocardiography demonstrated peak and mean gradients of 64 and 33 mmHg, respectively in the left ventricular outflow tract (LVOT) and a calculated orifice area by continuity equation of 1.14 cm(2) consistent with significant obstruction. However, by direct en face visualization of the LVOT at the level of the membrane by live/real time three-dimensional transthoracic echocardiography (3D TTE), a larger orifice measuring 2.29 cm(2) was seen and was indicative of no significant obstruction. This finding was confirmed at cardiac catheterization, which showed insignificant obstruction.

Traumatic tricuspid papillary muscle and chordae rupture: emerging role of three-dimensional echocardiography.

We describe a patient with blunt traumatic chest injury in whom three-dimensional transthoracic echocardiography (3DTTE) confirmed the findings of a flail anterior tricuspid valve leaflet and ruptured anterior papillary muscle seen on two-dimensional transthoracic echocardiography, and in addition identified multiple chordae tendinae rupture of the posterior leaflet. Open heart surgery confirmed the findings. The emerging role of 3DTTE in defining the true extent of traumatic tricuspid valvular injury is highlighted.

Initial experience with live/real time three-dimensional transesophageal echocardiography.

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.