VALUE OF 3-DIMENSIONAL ECHOCARDIOGRAPHY AS AN ADJUNCT TO CONVENTIONALTRANSESOPHAGEAL ECHOCARDIOGRAPHY

Three-dimensional imaging of cardiac structures could enhance the func tional understanding and the interpretation of pathologies. Limited pr ocessing capabilities, relocation problems and inadequate two-dimensio nal image quality have previously limited its applicability. Recently, an integrated echocardiographic computerized tomography unit (echo-CT ) which uses a transesophageal approach has been developed. This syste m is capable of sampling and processing multiple echocardiographic ima ges and, thus, provides three-dimensional views. To evaluate the feasi bility and potential of this technique, we studied 69 patients with va rious cardiac disorders. All but 3 patients (96%) tolerated the proced ure well allowing at least one scan to be performed. No complications were encountered. The indication for echo-CT included coronary artery disease (n = 4), mitral valve disease (n = 18), suspected arterial emb olism (n = 19), masses (n = 8), congenital malformation (n = 10), post cardiac surgery (n = 8), aortic aneurysm (n = 1) and suspected left-to -right shunt (n = 1). Conventional transesophageal echocardiography re vealed a pathology in 45 patients. Of these pathologies, 37 (82%) coul d be reconstructed and displayed in three-dimensional views. Three-dim ensional imaging provided an improved spatial understanding of the pat hology in 21 cases (39%). Echo-CT was especially valuable in diseases of the mitral valve (i.e. mitral valve prolapse, flail leaflets, mitra l stenosis) where it had the potential to delineate the location, type and morphology of defects. In conclusion, three-dimensional transesop hageal imaging enhances image interpretation and understanding. This c ould be of value in complex morphologies and cardiac disorders in whic h surgical repair is attempted.