Educational Series in Congenital Heart Disease: Three-dimensional echocardiography in congenital heart disease

Figures

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  Figure 1. Algorithm of different 3D echocardiography modalities. This serves as a general guide to the modality to use for acquisition.

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  Figure 2. Zoom mode. In the zoom mode a specific region of interest is selected by adjustment of the imaging box (A). Once activated the orientation of the box can be adjusted on cart to optimize visualization of the region of interest (B). This modality can be truly live or else acquired over multiple cardiac cycles. Multiple cardiac cycles will improve frame rate but at the risk of stitch artifacts.

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  Figure 3. (A) Shows the contours of the right ventricle in the four-chamber, sagittal and coronal planes which are used to construct the 3D volume which is shown in (B) along with the rendered 3D image of the right ventricle.

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  Figure 4. 3D transoesophageal image of a true posterior cleft in the mitral valve visualized from the left atrium. AMVL, anterior mitral valve leaflet; PMVL, posterior mitral valve leaflet.

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  Figure 5. Segmented model of a complete atrioventricular septal defect visualized from the ventricular aspect of the valve. Image courtesy of Dr Matthew Jolley, Children’s Hospital of Philadelphia, USA. IBL, inferior bridging leaflet; LML, left mural leaflet; LSBL, left superior bridging leaflet; RML, right mural leaflet; RSBL, right superior bridging leaflet.

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  Figure 6. (A) 3D Transoesophageal echocardiogram of an atrial septal defect, visualized from the right atrium. This acquisition has retained adjacent structures so that the size and location of the defect is clear. (B) 3D transoesophageal echocardiogram of an atrial septal defect visualized from the left atrium. Ao, aorta; ASD, atrial septal defect; CS, coronary sinus; LV, left ventricle; MV, mitral valve; RV, right ventricle; TV, tricuspid valve.

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  Figure 7. Transthoracic 3D echocardiogram of a perimembranous ventricular septal defect projected from the right ventricular aspect (A) and left ventricular aspect (B). (A) This view shows the relationship of the VSD to the tricuspid valve and right ventricular outflow tract. (B) This view, from the left ventricular aspect, shows the relationship of the VSD to the aortic valve. LV, left ventricle; RA, right atrium; RV, right ventricle; RVOT, right ventricular outflow tract; TV, tricuspid valve; VSD, ventricular septal defect.

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  Figure 8. Transthoracic 3D echocardiographic interrogation of a patient with usual atrial arrangement, discordant atrioventricular connections and double outlet right ventricle. This was done to plan surgery, including feasibility of routing of blood flow from the morphologic left ventricle to the aorta. (A) View from the ventricular apex. (B) Multiplanar reformatted image using cropping tools. The plane of visualization is from the red dotted line into the white box. (C) 3D rendered image of the projection defined in (B). This shows the position of the tricuspid valve which overlies a large ventricular septal defect (outlined by asterisks) and the location of the aorta and pulmonary artery in relation to the ventricular septal defect. Ao, aorta; LA, left atrium; mLV, morphologic left ventricle; mRV, morphologic right ventricle; MV, mitral valve; PA, pulmonary artery; TV, tricuspid valve; VSD, ventricular septal defect.

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  Figure 9. Transoesophageal 3D echocardiography during occlusion of atrial septal defect. (A) Transoesophageal 3D echocardiogram from a right atrial view showing a catheter coursing superiorly, adjacent to a large atrial septal defect. The depth of field of the 3D technique permits visualization of both defect and catheter. (B) Left atrial view of ASD occlusion device and delivery catheter. LA, left atrium; RA, right atrium.

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  Figure 10. 3D printed model of double outlet right ventricle in an infant. This model was produced from cardiac MRI and was created to assist surgical planning, in particular with respect to routing of blood from the left ventricle to the aorta. The model is viewed from the right, with the right ventricular free wall reflected away. The proposed route is shown by the orange tubing.

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  Figure 11. This image shown blood speckle tracking through a ventricular septal defect. The direction and velocity of flow is indicated by the direction and length of the arrows respectively. Reprinted from Ultrasound in Medicine and Biology, Vol 40, Fadnes S, Nyrnes SA, Torp H & Lovstakken L, Shunt flow evaluation in congenital heart disease based on two-dimensional speckle tracking, Pages 2379–2391, Copyright (2014), with permission from Elsevier (34).

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  Figure 12. 3D echocardiography derived intra-ventricular flow in a patient with HLH based on multiple 3D echocardiographic acquisitions. Image reconstruction by Dr Alberto Gomez, King’s College London.