internal medicine

1. People are trying to be smart - all I am trying to do is not to be idiotic, but it's harder than most people
think.
-Charlie Munger
3D ECHO
INTRODUCTION
Noninvasive diagnostic tool for real-time imaging of cardiac structure and function.
2D echo provides details only along 2 axis
3D produces images on the X YZ axis to allow a very detailed image of the height, width , depth
of the human heart.
Many of the limitations of two-dimensional (2D) echocardiography due to need for modelling
Nearly all studies that have directly compared the accuracy of 3D measurements of LV volumes
and LV ejection fraction have demonstrated the superiority of the 3D approach over the
traditional 2D methodology.
WHY SHOULD WE PERFORM 3D ECHOCARDIOGRAPHY?
• Heart is a highly dynamic organ with active and passive motion
• Complicated 3D anatomy
• Even more complicated 3D mechanical function and motion
• 3D diagnosis and quantification frequently more detailed, accurate and precise
• New diagnostic opportunities
• Superior communication of diagnostic information
ADVANTAGES
● New physiological and pathophysiological knowledge
● Far more accurate and precise assessment of LV size and function
● Improved characterisation of valvular and other structural heart disease
● Superior communication of pathoanatomy and pathophysiology
● Platform for 3D deformation analysis (3D STE), e.g. in LV dyssynchrony
● Improvement in the accuracy and reproducibility of the evaluation of cardiac chamber
volumes by eliminating the need for geometric modeling and the errors caused by
foreshortened apical views
● Due to the complex crescent shape of the right ventricle (RV), estimation of its volume
based on geometric modeling from 2D images has been challenging. The intrinsic ability
- Created with love
by Dr. Eashan Srivastava

2. People are trying to be smart - all I am trying to do is not to be idiotic, but it's harder than most people
think.
-Charlie Munger
of 3D imaging to directly measure RV volumes without the need for geometric modeling
has resulted in significant improvements in accuracy and reproducibility in RV volume
quantification.
PROBLEMS WITH 3D ECHO
• Equipment availability
• Education and hands-on training
• Simplified and highly automated procedures
• Further improvement in spatial and temporal resolution
• One-beat Full Volume with adequate image quality and volume rate
• Easier integration into 2D examination
CLINICAL APPLICATIONS
● To enhance the understanding of failed and failing cardiac valves.
● Planning and real time operational stage for valve repairs, closure of cardiac defects
● Understanding of prosthetic valve function
● To help in assessing proper valve placement and positioning
● Diagnosing this complication of prosthetic valves
● Safe guidance of clip delivery system via left atrium to the mitral valve, exact positioning
of the clip in the middle of the intercommisural line at the center of the jet and accurate
alignment of the clip
● TAVR aortic valve replacements.
● Search for embolus in the left atria
● Use three dimensional echo to assess shape of left atria in cases of mitral stenosis for
early embolus formation.
● Assess aortic valve stenosis. 3D AVA measurements correlate well with 2D AVA but is
smaller suggesting that the AS orifice is not planer but is more of a tunnel
● Echocardiography guided interventional procedures
o TAVI
o MitraClip
- Created with love
by Dr. Eashan Srivastava

3. People are trying to be smart - all I am trying to do is not to be idiotic, but it's harder than most people
think.
-Charlie Munger
o Closure of prosthetic paravalvular leak
o Closure of LAA
o Closure of ASD / PFO
● Congenital heart disease
● Tricuspid and pulmonic valve disease
● Endocarditis
● Aortic dissection
● Intracardiac tumour, thrombus, vegetation
- Created with love
by Dr. Eashan Srivastava