3D and 4D Ultrasound: Current Progress and Future Perspectives

Abstract

Purpose of review: Three-dimensional (3D) echocardiography (3DE) and 4-dimensional echocardiography (4DE), also known as real-time (RT) 3DE (RT3DE), are rapidly emerging technologies which have made significant impact in the clinical arena over the years. This review will discuss the recent applications of 3DE in diagnosing and treating different types of cardiovascular disease.

Recent findings: Recent studies using 3DE expanded on prior findings and introduced additional applications to different cardiac conditions. Some studies have used 3D parameters to prognosticate long-term outcomes. Numerous innovative software designs including fully automated algorithms have been introduced to better evaluate valvular heart disease and cardiac function.

Summary: With further evolution of 3DE technologies, this imaging modality will emerge as a powerful tool and likely become the imaging modality of choice in the diagnosis and management of various cardiac disorders.

Keywords: 3-dimensional echocardiography; Strain imaging; Transcatheter valve replacement; Valvular heart disease; Ventricular function.

Fig. 1

Pre-procedure 3D TEE showing a mitral annuloplasty ring with an unrepaired cleft in the anterior mitral leaflet

Fig. 2

Pre-procedure 3D TEE with color flow Doppler showing severe mitral regurgitation originating from the unrepaired cleft in the anterior mitral leaflet

Fig. 3

Pre-procedure TEE measurement of the distance between the tip of the anterior mitral leaflet and the septum (important in the assessment of the probability of obstruction of the left ventricular outflow tract from a contemplated transcatheter mitral valve implant)

Fig. 4

Pre-procedure TEE measurement of the peak and mean gradients across the aortic valve (important to document prior to transcatheter mitral valve implantation to ensure that there has been no obstruction of the left ventricular outflow tract)

Fig. 5

Guidance of the transapical catheter along the true long axis of the left ventricle (important to obtain views of the left ventricle that are not foreshortened)

Fig. 6

Guidance of the transapical catheter such that is visualized to be in the center of the mitral annulus in the biplane view

Fig. 7

Rapid pacing prior to deployment of the transcatheter valve in order to minimize cardiac motion

Fig. 8

Post-procedure 3D TEE showing a well seated Sapien aortic prosthesis in the mitral position (off label use)

Fig. 9

Post-procedure 3D TEE with color flow Doppler showing no significant residual mitral regurgitaton after deployment of a Sapien aortic prosthesis in the mitral position using a transapical approach (off label use)