Three-dimensional Echocardiography

313 Pages·2015·32.127 MB·English

by  Prof. Dr. Thomas Buck, Prof. Dr. Andreas Franke, Dr. Mark J. Monaghan (eds.)

Buck · Franke
Monaghan Eds.
Three-dimensional
Echocardiography
2nd Edition
with
DVD-ROM
Three-dimensional Echocardiography
Thomas Buck
Andreas Franke
Mark J. Monaghan (Eds.)
Three-dimensional
Echocardiography
Second fully revised edition
With 877 figures and 518 videos
123
Editors
Prof. Dr. Thomas Buck Dr. Mark J. Monaghan
Klinikum Westfalen King’s College Hospital
Dortmund London
Germany UK
Prof. Dr. Andreas Franke
Klinikum Siloah
Hannover
Germany
You can also find all video material for this book at:
http://www.springermedizin.de/vzb-echocardiography
ISBN-13 978-3-642-36798-4 ISBN 978-3-642-36799-1 (eBook)
DOI 10.1007/978-3-642-36799-1
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V
Prefa ce
Real-time three-dimensional (3D) echocardiography, makes this book an invaluable companion, when wor-
which became commercially available in 2002, is the king with real-time 3D echocardiography, is an in-
most recent, major advancement in echocardiogra- depth review of the most recent literature which is
phy. Providing direct viewing of 3D cardiac surfaces provided in each chapter.
during live scanning, it adds fundamentally new in-
formation to the echocardiographic assessment of The book contains a large number of comprehensively
heart diseases, and it has already significantly changed illustrated clinical case examples, which demonstrate
echocardiographic diagnoses. Although echocardio- how real-time 3D modifies decision-making in echo-
graphic examiners are used to interpreting cross-sec- cardiographic practice. However, while focusing on
tional images, conventional two-dimensional (2D) real-time 3D echocardiography, the book does not
echocardiography requires mental 3D reconstruction claim to be a full textbook on either echocardiography
of cardiac structures. This is prone to error and can be or on cardiac diseases.
difficult to communicate. Real-time 3D echocardio-
graphy, in contrast, provides direct, anatomically rea- To illustrate the added benefit of 3D image informati-
listic visualization of 3D structures, such as an en face on, most case examples also include conventional 2D
view from the left atrium to the mitral valve or the image information for comparison. However, it is im-
direct view of a multifenestrated atrial septum. Bey- portant to emphasize that the authors have aimed to
ond this, real-time 3D echocardiography allows for highlight the complementary nature of the two tech-
the first time accurate quantitative assessment of niques where, on the one hand, 3D visualization adds
structures, volumes and spatial relationships without important diagnostic information to a standard 2D
any geometric assumptions. Therefore, this gives the echocardiographic examination and, on the other
technique a unique advantage over conventional 2D hand, 2D cross-sectional information on structure
echocardiography. and thickness of valves, walls, and masses is indispen-
sible for complete understanding of 3D datasets.
However, the practical application and data analysis
of real-time 3D echocardiography has been shown to EyeCatcher
substantially differ from conventional 2D echocardi-
Real-time 3D echocardiography and
ography. While in 2D echocardiography, the image
conventional 2D echocardiography should be
information is all obtained from a 2D sector view that
considered complementary modalities.
is manually optimized to present the best image infor-
mation, real-time 3D datasets facilitate unlimited vie-
wing from all directions of the dataset and unlimited The authors of this book have all been intensely invol-
viewing perspectives of structures within the dataset. ved in interactive training courses on 3D echocardio-
This freedom of unlimited 3D visual assessment, graphy over the past years and have included their
however, requires knowledge and experience about training experience as well as the most illustrative case
how to live scan, acquire, and analyze volumetric da- examples into each chapter. Thus, this book serves as
tasets. a valuable educational compendium to both individu-
al learning experiences as well as expert-guided trai-
EyeCatcher ning courses.
Practical application and data analysis of real-
Since a strong focus of the book is on practical appli-
time 3D echocardiography differs substantially
cation of real-time 3D echocardiography in daily cli-
from conventional 2D echocardiography.
nical routine, its chapters and case examples are orga-
nized so as to provide valuable tips and tricks for both
This book is both an illustrated textbook and a practi- beginners and experts. In addition, because the heart
cal guide to real-time 3D echocardiography. It provi- and echocardiographic imaging are both dynamic
des a comprehensive overview of this fascinating and because dynamic information is critical for un-
technology covering all clinically important aspects, derstanding, the majority of echocardiographic ima-
including a substantial explanation of the basic prin- ges within the book are accompanied by the full video
ciples of 3D technology, step-by-step introductions to sequences on the included DVD.
basic aspects of clinical application, and detailed de-
scriptions of specific applications in the broad spect-
rum of clinically important heart diseases. What also
VI Prefa ce
j 2nd edition time 3D echocardiography. Furthermore, the recent
After a very successful 1st edition, with more than techn ical advancements have resulted in real-time 3D
1000 copies sold, this book presents the 2nd edition echocardiography being used in new places in cardiac
which is a full revision of the 1st edition, preserving centers. For example, periinterventional guidance and
the overall concept and structure of the book but ad- monitoring in the catheterization lab has become and
ding a comprehensive update of all chapters with new will continue to be the most rapidly progressing clini-
illustrative cases, new recommendations from recent cal application of real-time 3D echocardiography.
guidelines, and new important literature.
Thus, we believe that a 2nd edition of the book is time-
Since the 1st edition was published in 2011, the field of ly and hope it will be as valuable to readers of various
real-time 3D echocardiography has demonstrated professions like sonographers, physicians, scientists,
marked progress with new 3D acquisition software and students, as the first apparently was.
solutions such as one-beat full volume and live 3D
color-Doppler, new 3D analysis software solutions Thomas Buck
such as the heart model 3D volumetry and the 3D Andreas Franke
n avigator, and, importantly, publication of several re- Mark J. Monaghan
commendations on the clinical application of real- June 2014
VII
About the editors
j Thomas Buck, MD, FACC, FESC
Thomas Buck is Associate Professor of Medicine and Cardiology at the University Duisburg-Essen,
Germany. Since 2014, he is Director of the Department of Cardiology of the Klinikum Westfalen
in Dortmund, Germany. Prior to this at the University Hospital Essen, he held the position of
Director of Echocardiography Laboratories as well as the appointments of Chief Consultant and
Assistant Director of the Department of Cardiology at the West German Heart Center. Since the
beginning of his academic career in 1992, 3D echocardiography has been a major field of his
scientific interest. One of his primary clinical areas of expertise is the management of heart valve
disease patients, where his early scientific work was stimulated while working as a Research
Fellow at Massachusetts General Hospital, Boston, USA. As one of his official assignments, he was
the Chair of the German Working Group of Echocardiography from 2005–2011. In addition to
a considerable number of scientific articles and clinical guidelines, his work includes several
teaching book contributions and international patents in the field of echocardiography. Since the
introduction of real-time 3D echocardiography into clinical practice, he has regularly organized
national and international training courses as an expert trainer.
j Andreas Franke, MD, FESC
Andreas Franke is Associate Professor of Medicine and Cardiology and Director of the Depart-
ment of Cardiology, Angiology and Intensive Care Medicine of the Klinikum Siloah in Hannover,
Germany. During his clinical and academic career starting in 1988 at the RWTH Technical Univer-
sity Aachen, Germany, echocardiography and congenital heart disease in adults have been
his main fields of scientific interest and work. His primary clinical areas of expertise besides non-
invasive cardiac imaging are the interventional therapy of coronary artery disease and the
management of valvular disease. Since the early 1990s, he has been involved in further develop-
ment of 3D echocardiography and has published numerous clinical studies on the topic.
Between 1998 and 2001, he was a nucleus member of the Working Group on Echocardiography
of the ESC as an organizer of the subgroup 3D echocardiography. Over the last 15 years, he also
contributed to several textbooks and atlases on echocardiography. Moreover, since 2003 he
regularly organizes national real-time 3D echocardiographic training courses as an expert trainer.
j Mark J. Monaghan PhD, FRCP(Hon), FACC, FESC
Mark J. Monaghan is a Professor of Echocardiography, Director of Non-Invasive Cardiology and
Associate Medical Director at King’s College Hospital, London UK. He has worked in the field of
echocardiography for over 25 years and has published extensively on the subject, especially on
the use of 3D. In addition, he holds two international patents on echocardiographic technology
and lectures widely at international meetings and cardiology conferences throughout the world.
He runs several teaching courses and workshops on 3D echocardiography every year and has
contributed to and co-edited several textbooks. Professor Monaghan has been a board member
of the European Association of Echocardiography and is a past President of the British Society
of Echocardiography.
Content
1 Three-dimensional e chocardiography: lessons in overcoming time and space . . . . . . . . . 1
Jos R.T.C. Roelandt, Joseph Kisslo
1.1 Reconstruction techniques . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
1.1.1 The linear scanning approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
1.1.2 The fan-like scanning approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
1.1.3 The rotational scanning approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
1.2 Volumetric real-time (high-speed) s canning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
1.3 High speed imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
1.4 The future is based on the past . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
2 Basic principles a nd practical application . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Thomas Buck, Karl E. Thiele
2.1 How real-time 3D ultrasound works . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
2.1.1 It’s all about the transmit beams . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
2.1.2 The need for bigger, better, faster . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
2.1.3 Fully sampled matrix array transducers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
2.1.4 Parallel receive beam processing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
2.1.5 Three-dimensional color flow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
2.1.6 Principle of depth volume rendering for 3D imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
2.2 The probes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
2.3 Live 3D echocardiographic examination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
2.3.1 First steps and learning curve . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
2.3.2 Three-dimensional acquisition (modes and image settings) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
2.3.3 Standard 3D views and image orientation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
2.4 Basic 3D analysis: cropping and slicing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
2.4.1 First steps of 3D dataset cropping . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
2.5 Basic 3D measurements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
2.6 Artifacts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
2.6.1 Stitching artifacts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
2.6.2 Dropout artifacts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
2.6.3 Blurring and blooming artifacts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
2.6.4 Gain artifacts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
3 Left ventricular and left atrial function . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
Harald P. Kühl
3.1 Assessment of left ventricular volumes and ejection fraction . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
3.2 Evaluation of left ventricular mass . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
3.3 Assessment of regional left ventricular function . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
3.4 Determination of left ventricular d yssynchrony . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70
3.5 Parametric imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70
3.6 Transesophageal real-time 3 D echocardiography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
3.7 Three-dimensional assessment o f left atrial volume and function . . . . . . . . . . . . . . . . . . . . . . . . 75
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
4 Three-dimensional s tress echocardiography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
Andreas Franke
4.1 Method . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80
4.2 Clinical studies on 3D stress echocardiography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
4.3 Limitations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86
4.4 New approaches and future perspectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
IX
Content
5 Cardiac dyssynchrony . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
Mark J. Monaghan, Shaumik Adhya
5.1 Technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90
5.1.1 Acquisition of 3D volumes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90
5.1.2 Measures of intraventricular dyssynchrony . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90
5.1.3 Performing 3D analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
5.1.4 Measurement variability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94
5.2 Normal values . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98
5.3 Dyssynchrony in heart failure a nd left bundle branch block . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
5.3.1 Relationship between left ventricular function and dyssynchrony . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
5.3.2 Patterns of dyssynchrony . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
5.3.3 SDI as a predictor of outcome of cardiac resynchronization therapy . . . . . . . . . . . . . . . . . . . . . . . . . . 101
5.4 Dyssynchrony due to right ventricular pacing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102
5.5 Dyssynchrony in other situations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
5.5.1 In children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
5.5.2 In postsurgical correction of congenital heart disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
5.5.3 After acute myocardial infarction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
5.5.4 In amyloidosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104
5.6 Assessment of dyssynchrony after CRT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104
5.7 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
6 The right ventricle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
Stephan von Bardeleben, Thomas Buck, Andreas Franke
6.1 Assessment of right ventricular volumes and function . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
6.2 New aspects of 3D right ventricular a nalysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
7 Valvular heart disease – i nsufficiencies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
Thomas Buck
7.1 Mitral regurgitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118
7.1.1 Morphologic evaluation of mitral valve insufficiency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
7.1.2 Classification of mitral valve insufficiency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
7.1.3 Mitral valve prolapse, flail, and Barlow’s disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
7.1.4 Mitral valve quantification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127
7.1.5 Papillary muscle rupture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133
7.1.6 Functional mitral regurgitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135
7.1.7 Endocarditis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137
7.1.8 Mitral valve prosthesis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139
7.1.9 Mitral valve repair . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141
7.1.10 Rare etiologies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145
7.1.11 Assessment of severity of mitral regurgitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147
7.2 Aortic regurgitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160
7.3 Right-sided heart valves . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168
8 Valvular heart disease – stenoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171
José Alberto de Agustin, José L. Zamorano
8.1 Evaluation of mitral valve stenosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 172
8.1.1 Morphological assessment of the mitral valve . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 172
8.1.2 Functional assessment of mitral stenosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 172
8.2 Evaluation of aortic valve stenosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179
8.2.1 Morphological assessment of aortic stenosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179
8.2.2 Functional assessment of aortic stenosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 182
8.3 Evaluation of tricuspid and pulmonary valve stenosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187
8.4 Evaluation of prosthetic a nd reconstructed valves . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191
X Content
9 Congenital heart disease i n adults . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195
Folkert J. Meijboom, Heleen van der Zwaan, Jackie McGhie
9.1 Patent foramen ovale . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198
9.2 Atrial septal defect . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198
9.3 Ventricular septal defect . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203
9.4 Atrioventricular septal defects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205
9.5 Ebstein’s anomaly . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209
9.6 Transposition of the great arteries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 212
9.7 Congenitally corrected transposition of the great arteries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 214
9.8 Tetralogy of Fallot . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 216
9.9 RT3DE in other congenital cardiac m alformations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 216
9.10 Role of RT3DE in the analysis o f right ventricular function . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 216
9.10.1 Acquisition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 216
9.10.2 Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 219
9.11 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 219
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221
10 Congenital heart disease in children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 223
John M. Simpson, Owen I. Miller
10.1 Technical and patient-specific factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 224
10.2 Selection of imaging probes in children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 224
10.3 Presentation of 3D echocardiographic i mages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 226
10.4 Types of cardiac lesions which can b e assessed using 3D echocardiography . . . . . . . . . . . . . . . . . 226
10.4.1 Abnormalities of venous drainage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227
10.4.2 Atrial septal defects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227
10.4.3 Ventricular septal defects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227
10.4.4 Atrioventricular valves . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 232
10.4.5 Atrioventricular septal defects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 232
10.4.6 Mitral valve abnormalities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 232
10.4.7 Ebstein’s anomaly of the tricuspid valve . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 232
10.4.8 Atrioventricular junction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 232
10.4.9 Complex anatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 235
10.5 Three-dimensional echocardiography d uring catheter intervention and surgery . . . . . . . . . . . . . . 237
10.5.1 Imaging during catheter intervention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237
10.5.2 Imaging during surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237
10.6 Role of RT3DE in the assessment o f cardiac function in children . . . . . . . . . . . . . . . . . . . . . . . . . . 240
10.6.1 The left ventricle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 240
10.6.2 The right ventricle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 240
10.7 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 242
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 242
11 Cardiac tumors a nd sources of embolism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 245
Björn Plicht
11.1 Sources of embolism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 246
11.1.1 Cardiac and vascular thrombi, spontaneous echo contrast . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 246
11.1.2 Patent foramen ovale . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 250
11.1.3 Infective endocarditis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 254
11.2 Primary cardiac tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 258
11.2.1 Primary benign cardiac tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 258
11.2.2 Primary malignant tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 260
11.3 Secondary cardiac tumors and metastases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 262
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 264
12 Monitoring and guiding cardiac interventions and surgery . . . . . . . . . . . . . . . . . . . . . . . 267
Harald P. Kühl, Andreas Franke, Thomas Buck
12.1 Method . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 268
12.2 Intraoperative monitoring and guiding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 268