Delineation of the etiology of a mass-like echo density in the left ventricle using three-dimensional transthoracic echocardiography.

Live/real time three-dimensional transthoracic echocardiography (3DTTE) provides an incremental value in the delineation of various cardiac pathologies. In this study, two-dimensional transthoracic echocardiography (2DTTE) of a 56-year-old patient showing a prominent echo density suggestive of a mass in the left ventricle probably attached to the ventricular side of the anterior mitral leaflet, is reported. Systematic cropping of the 3DTTE dataset showed the mass to be a calcified mitral strut chord viewed in cross section. This is well visualized in the accompanying movie clip. This case highlights the advantage of 3DTTE in which the whole of the ventricle including the mitral valve apparatus is captured in the dataset facilitating cropping at any desired angulation.

Incremental value of live/real time three-dimensional echocardiography in the diagnosis and evaluation of pericardial cyst.

Pericardial cysts are rare anomalies of the pericardium that are usually asymptomatic and followed by two-dimensional (2D) echocardiography. Here we report a large pericardial cyst that could not be measured accurately by 2D echocardiography but three-dimensional (3D) echocardiography enabled measurements of the cyst that correlated well with computed tomography measurements. In addition, 3D echocardiography demonstrated the mono-trabeculated nature of the cyst further suggesting the incremental value of 3D echocardiography in the evaluation of pericardial cysts. The cyst was subsequently resected surgically.

The ability of live three-dimensional transesophageal echocardiography to evaluate the attachment site of intracardiac tumors.

In this study, a case of a right ventricular myxoma and a case of a right ventricular hemangioma are used to demonstrate the ability of live three-dimensional transesophageal echocardiography (3DTEE) to assess the site of tumor attachment. Because 3DTEE has the ability to visualize desired structures in multiple planes, we defined the attached portion of the tumors and measured the en face view dimensions. In addition, the improved ability of 3DTEE to evaluate tissue characteristics allowed differentiation of the heterogeneous myxoma and highly vascular hemangioma. On the contrary, because two-dimensional (2D) TEE only allows structures to be viewed in a 2D plane, the attachment site can be located but complete delineation and measurement of area is not possible. As surgical options become less invasive, accurate attachment site location and size will become more important to ensure complete excision.

Incremental value of live/real time three-dimensional over two-dimensional transesophageal echocardiography in the evaluation of right coronary artery fistula.

We report an adult with a right coronary artery to right atrial fistula in whom live/real time three-dimensional transesophageal echocardiography with its ability to trace the entire course and obtain en face views of the fistula connections, was able to provide significant incremental information over two-dimensional transesophageal echocardiography.