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An Urban Experience
Assessment of valvular anatomy and function
Detailed assessment of valvular anatomy and function can be achieved by advanced RT3D echocardiogaraphy. RT3D echocardiography provides unique en face views of valve structures because of its flexibility in plane alignment. A comparative study in human patients
with mitral valve prolapse showed that segmental analysis of the prolapsing valve using transthoracic
(TTE) RT3D echocardiography was as accurate as
with transesophageal (TEE) 2D echocardiography. Transthoracic RT3D echocardiography also has a potential to become a valuable tool for assessment
of mitral valve structures in canine patients, and the potential has recently been demonstrated in canine studies. Modern RT3D digital software provides quantification programs for performing shape analysis
of mitral valve morphology (leaflets and annulus) from images collected by RT3D echocardiography.
Assessment of congenital deformations
RT3D echocardiography displays the relationship of cardiac structures in space and has the potential to optimize visualization of complex cardiac structures; which makes it appealing for use in patients with congenital heart disease. RT3D echocardiography can provide novel views of septal defects and estimation of ventricular septal defects by RT3D echocardiography has been shown to better correlate with surgical findings compared to 2D echocardiography in human cardiac patients. RT3D echocardiography can also be a valuable tool for assessing aortic and pulmonic stenoses due to improved visualization of the valve and root.
Intracardiac masses, such as thrombi or tumours, are often of irregular shapes, which challenge size determination when using 2D echocardiography. By including the entire volume of the mass; morphology, spatial location and extent of cardiac masses can
be further characterized in multiple planes; allowing more accurate assessments of structures by RT3D echocardiographic techniques.
In summary, 3D echocardiography has evolved from a time-consuming research tool to a clinically applicable diagnostic technique with the potential of providing supplementary information to conventional 2D echocardiography. With increasing clinical experience in animals, and with further advances in computer technology, RT3D echocardiography will likely continue to expand the range of applications in routine clinical assessment of cardiac patients.
Suggested reading
1. Sheikh K, Smith SW, von Ramm O, Kisslo J. Real-time, three-dimensional echocardiography: feasibility and initial use. Echocardiography. 1991;8(1):119-25.
2. Lang RM, Mor-Avi V, Sugeng L, Nieman PS, Sahn DJ. Three-dimensional echocardiography: the benefits of the additional dimension. J Am Coll Cardiol. 2006;48(10):2053-69.
3. Jacobs LD, Salgo IS, Goonewardena S, Weinert L, Coon P, Bardo D, et al. Rapid online quantification of left ventricular volume from real-time three- dimensional echocardiographic data. Eur Heart J. 2006;27(4):460-8.
4. Lu X, Xie M, Tomberlin D, Klas B, Nadvoretskiy V, Ayres N, et al. How accurately, reproducibly, and efficiently can we measure left ventricular indices using M-mode, 2-dimensional, and 3-dimensional echocardiography in children? Am Heart J. 2008;155(5):946-53.
5. Tidholm A, Westling AB, Hoglund K, Ljungvall I, Haggstrom J. Comparisons of 3-, 2-dimensional, and M-mode echocardiographical methods for estimation of left chamber volumes in dogs with and without acquired heart disease. J Vet Intern Med. 2010;24(6):1414-20.
6. Ljungvall I, Hoglund K, Carnabuci C, Tidholm A, Haggstrom J. Assessment
of Global and Regional Left Ventricular Volume and Shape by Real-Time 3-Dimensional Echocardiography in Dogs with Myxomatous Mitral Valve Disease. Journal of veterinary internal medicine / American College of Veterinary Internal Medicine. 2011.
7. Menciotti G, Borgarelli M, Aherne M, Haggstrom J, Ljungvall I, Lahmers
SM, et al. Assessment of mitral valve morphology using three-dimensional echocardiography. Feasibility and reference values. J Vet Cardiol. 2016;18(2):156- 67.
8. Menciotti G, Borgarelli M, Aherne M, Wesselowski S, Haggstrom J, Ljungvall I, et al. Mitral valve morphology assessed by three-dimensional transthoracic echocardiography in healthy dogs and dogs with myxomatous mitral valve disease. J Vet Cardiol. 2017;19(2):113-23.

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