Ebstein's anomaly assessed by real-time 3-D echocardiography.

The outcome of patients with Ebstein's malformation depends mainly on the severity of the tricuspid valve malformation. Accurate description of the tricuspid anatomy by two-dimensional echocardiography remains difficult. We applied real-time three-dimensional echocardiography to 3 patients with Ebstein's anomaly. Preoperative and postoperative descriptions of the tricuspid valve were obtained from views taken inside the right ventricle. Surface of the leaflets as well as the commissures were obtained by three-dimensional echocardiography. Real time three-dimensional echocardiography is a promising tool, providing new views that will help to evaluate the ability and efficiency of surgical valve repair in patient with Ebstein's malformation.

Real-time three-dimensional fetal echocardiography using matrix probe.

OBJECTIVE: To investigate the feasibility of using real-time three-dimensional echocardiography (3DE) to evaluate the fetal heart. METHODS: Sixty fetuses were studied with gestational age between 22 and 34 weeks. The fetal heart was normal in 44 fetuses. In 16 fetuses, the fetal heart had morphologic abnormalities (hypoplastic left ventricle in 4, tetralogy of Fallot in 2, Ebstein anomaly in 2, rhabdomyomes in 2, hypoplastic right ventricle in 1) or myocardial dysfunction (in 5 fetuses). Real-time 3DE was performed with a cardiac matrix probe (2-4 MHz). Two modalities of 3D imaging were performed: Biplane and Live 3D imaging. RESULTS: Real-time 3DE was performed successfully in 93%. Biplane imaging allowed a multiplanar scanning of the fetal heart. Using rotation, lateral and vertical tilts, the normal cardiac structures were identified from a unique reference image plane: atria and ventricles, atrioventricular valves, aorta and pulmonary artery. Live 3D imaging allowed surface imaging of the fetal heart. 'En face' view of the foramen ovale from the right atrium was obtained, showing the shape of the orifice. By cropping the pyramidal imaging volume, ascending aorta, aortic arch and ductus arteriosus were depicted from a single dataset. In pathologic fetal hearts, 3DE was helpful for (1) localizing multiple cardiac tumors; (2) estimating size and function of the right and left ventricles; (3) evaluating mechanism of valvular regurgitation and pulmonary obstruction. CONCLUSION: Real-time 3DE is a feasible and non-time-consuming method, allowing a multiplanar scanning and new inside 3D views of the fetal heart.

Assessment of atrial septal defect size with 3D-transesophageal echocardiography: comparison with balloon method.

BACKGROUND: Transcatheter closure of atrial septal defect (ASD) is an alternative approach to surgery in selected patients. Balloon stretched diameter (BSD) is considered as the standard way of measuring ASD size. Three-dimensional transesophageal echocardiography (3D-TEE) provides views of the ASD allowing its measurement and identifying its spatial relation with neighboring structures. Our aim was to compare the BSD and 3D-TEE methods to measure the ASD size before transcatheter closure. METHODS AND RESULTS: Seventy-six consecutive patients were enrolled for ASD device closure. Three-dimensional transesophageal echocardiography and balloon sizing were adequately performed in 70 patients before the defect closure. The mean maximal diameter measured by 3D-TEE was 20 +/- 15 mm (range 10-28) while the mean BSD was 22 +/- 4.8 mm (range 9-31). When comparing the 3D-TEE and transcatheter measurements, there was a good correlation between the two methods (y = 3.15 + 0.77x; r = 0.8). The defect as viewed by 3D-TEE was unique in 54 patients and multiple in 16 patients. In patients with a single defect, the correlation between the two methods was high (y = 1.74 + 0.84x; r = 0.85) while patients with multiple ASDs, the correlation was poor (y = 12.4 + 0.4x; r = 0.45). Transcatheter closure was performed successfully in 86%. The mean size of the Amplatzer device was 23 +/- 4.8 mm (range 4-32). The reference to choose the size of the device was the BSD in single defects and the 3D-TEE maximal diameter in multiple defects. CONCLUSION: Three-dimensional transesophageal echocardiography and transcatheter methods are two complementary techniques for the success of transcatheter ASDs closure.