Three-dimensional reconstructions of normal and aneurysmatic left ventricles in vivo using transesophageal echocardiography

Objective: To perform three-dimensional surface reconstructions to provide spatial delineations of a normal and an aneurysmatic left ventricle, using transesophageal echocardiography. Design: Prospective study. Setting: University hospital. Participants: Eight patients in cardiogenic shock admitted to the intensive care unit and two patients undergoing surgery with general anesthesia. Interventions: Using a multiplane transesophageal echocardiography probe, n ine echocardiographic cross-sectional images of the heart at approximately 20 degrees angular increments were obtained from midesophageal level in eac h patient for three-dimensional surface reconstructions. Multiple determina tions of cardiac output using the thermodilution principle were also made i n each patient to verify the accuracy of three-dimensional data sets. Measurements and Main Results: End-diastolic and end-systolic volumes were determined from three-dimensional data sets using the disc-summation method . Stroke volume was derived as the difference between end-diastolic and end -systolic volumes. Stroke volume was also calculated from thermodilution ca rdiac output measurements and heart rate. Correlation and limits of agreeme nt between stroke volumes derived by the two methods were determined. Three -dimensional wire-frame models of a normal and an aneurysmatic left ventric le at end-systole were constructed from the nine echocardiographic cross-se ctional images. Correlation coefficient between stroke volume derived from three-dimensional data sets using the discsummation method and that measure d by the thermodilution method was 0.91 (p < 0.001). Wire-frame models reve al a normal symmetric cavity and an aneurysmal cavity in sharp relief. Conclusions: Three-dimensional surface reconstruction can be performed from multiple cross-sectional images obtained using an unmodified commercially available multiplane transesophageal echocardiography probe, to reveal the left ventricular cavity in sharp relief. High correlation between stroke vo lume calculated from three-dimensional data sets and that measured by the t hermodilution method attests to the accuracy of the three-dimensional data sets. Copyright (C) 2000 by W.B. Saunders Company.