Deepak Khanna

Quantification of Mitral Regurgitation by Live Three-Dimensional Transthoracic Echocardiographic Measurements of Vena Contracta Area: 3D TTE VENA CONTRACTA AREA FOR MR

We evaluated 44 consecutive patients who underwent standard two‐dimensional (2D) and live three‐dimensional (3D) transthoracic echocardiography (TTE), as well as left heart catheterization with left ventriculography. Mitral regurgitant vena contracta area (VCA) was obtained by 3D TTE by systematic and sequential cropping of the acquired 3D TTE data set. Assessment of mitral regurgitation (MR) by ventriculography was compared to measurements of VCA by 3D TTE and to 2D TTE measurements of MR jet area to left atrial area (RJA/LAA), RJA alone, vena contracta width (VCW), and calculated VCA. VCA from 3D TTE closely correlated with angiographic grading (rs= 0.88) with very little overlap. VCA of <0.2 cm2 correlated with mild MR, 0.2–0.4 cm2 with moderate MR, and >0.4 cm2 with severe MR by angiography. Ventriculographic grading also correlated well with 2D TTE measurements of RJA/LAA (rs= 0.79) and RJA alone (rs= 0.76) but with more overlap. Assessment of VCW and calculated VCA by 2D TTE agreed least with ventriculography (rs= 0.51 and rs= 0.55, respectively). Live 3D TTE color Doppler measurements of VCA can be used for quantitative assessment of MR and is comparable to assessment by ventriculography.

Live three-dimensional echocardiography of the human fetus.

The purpose of this study was to investigate the feasibility of using a new three‐dimensional ultrasound system to perform fetal echocardiographic examination in real time. The device consisted of a Philips Sonos 7500 (Andover, MA) ultrasound system and a 4 MHz, 4X matrix transducer. The study was approved by the Institutional Review Board and was performed with the informed consent of the mother. The study population consisted of 12 singleton fetuses with gestational ages of 16–37 weeks. Of these, ten fetuses had normal cardiac anatomy, one had complete atrioventricular septal defect, and the other a thickened tricuspid valve. The system allowed comprehensive visualization of fetal cardiac anatomy and color Doppler flow unattainable by two‐dimensional approaches. This preliminary investigation suggests that live three‐dimensional fetal echocardiography could be a significant tool for prenatal diagnosis and assessment of congenital heart disease in the human fetus. (ECHOCARDIOGRAPHY, Volume 20, November 2003)

Morphological Assessment of Left Ventricular Thrombus by Live Three‐Dimensional Transthoracic Echocardiography

We report the usefulness of live three‐dimensional transthoracic echocardiography (3DTTE) in the morphological assessment of a left ventricular thrombus. Using live 3DTTE, the thrombus could be easily viewed end‐on and from the sides. In addition, by cropping the 3D images sequentially in transverse (horizontal or short axis), longitudinal (vertical or long axis), frontal, and oblique planes, the degree and extent of lysis within the thrombus, which represents an integral part of the clot‐resolution process, could be comprehensively assessed. The site of attachment of the thrombus in the left ventricular apex and its morphology could also be fully evaluated in three dimensions by live 3DTTE.

Live three-dimensional transthoracic echocardiographic assessment of transcatheter closure of atrial septal defect and patent foramen ovale.

We report the usefulness of live three‐dimensional transthoracic echocardiography in the accurate assessment of the morphology and efficacy of Amplatzer transcatheter devices used for closure of atrial septal defect and patent foramen ovale.

Transthoracic and Transesophageal Echocardiographic Assessment of Mitral Regurgitation Severity: Usefulness of Qualitative and Semiquantitative Techniques

In this report, we review the advantages, limitations, and optimal utilization of various transthoracic and transesophageal echocardiographic (TTE and TEE) methods used for assessing mitral regurgitation (MR) as published in full‐length, peer‐reviewed articles since the color Doppler era began in 1984. In addition, comparison is made to other imaging modalities including catheter‐based, magnetic resonance and surgical assessment of MR. Although left ventricular (LV) angiography has been traditionally used for validation of various TTE methods and is time‐honored, its considerable limitations preclude it from being a real “gold standard.” Based on the reviewed literature, no clear “gold standard” for the assessment of MR can be identified at present, but newly emerging TTE and TEE techniques, such as three‐dimensional color Doppler, may have the potential to overcome some of the limitations of the two‐dimensional methods.

Live Three-Dimensional Transthoracic Echocardiographic Delineation of Patent Ductus Arteriosus

We report an adult patient with a patent ductus arteriosus in whom live three‐dimensional transthoracic echocardiography provided comprehensive assessment of the morphology and pathophysiology of the lesion. (ECHOCARDIOGRAPHY, Volume 21, July 2004)

Live Three-Dimensional Transthoracic Echocardiographic Assessment of Left Ventricular Hydatid Cyst

We report an adult patient in whom live three‐dimensional transthoracic echocardiography (3DTTE) complemented two‐dimensional transthoracic echocardiography (2DTTE) in making a definitive diagnosis of a hydatid cyst located in the left ventricular cavity. The parent hydatid cyst, as well as the daughter cysts, contained within it could be delineated by both 2DTTE and live 3DTTE. However, the tertiary or granddaughter cysts originating from the daughter cysts as well as great‐granddaughter cysts budding from tertiary cysts could be visualized only when the live 3DTTE data sets were cropped and sectioned sequentially using multiple cutting planes. In addition, apparent intrinsic mobility of some of the tertiary cysts implying viability was detected only by 3DTTE.

Live three-dimensional transthoracic echocardiographic assessment of coronary arteries.

In the present study, we are illustrating some of the adult patients in whom live three‐dimensional transthoracic echocardiography was found useful in assessing proximal and mid‐coronary arteries. (ECHOCARDIOGRAPHY, Volume 20, November 2003)

Live Three‐Dimensional Transthoracic Echocardiographic Assessment of Anomalous Origin of Left Coronary Artery from the Pulmonary Artery

We describe live three‐dimensional transthoracic echocardiographic (3DTTE) findings in a 52‐year‐old female who had previously undergone an aortopulmonary tunnel operation for anomalous origin of the left coronary artery (ACA) from the pulmonary artery. Three‐dimensional transthoracic echocardiography clearly delineated the origin of the ACA from the posterolateral aspect of the main pulmonary artery just above the pulmonary valve, the surgically created tunnel, as well as a small defect in the tunnel near the aortic end communicating with the pulmonary artery.

Transesophageal and transpharyngeal ultrasound demonstration of reversed diastolic flow in aortic arch branches and neck vessels in severe aortic regurgitation.

In the current study, we describe an adult patient with torrential aortic regurgitation due to an aortic dissection flap interfering with aortic cusp motion, in whom a transesophageal echocardiogram with the probe positioned in the upper esophagus and transpharyngeal ultrasound examination demonstrated prominent reversed flow throughout diastole in the left subclavian, left vertebral, left common carotid, and left internal carotid arteries. Another unique finding was the demonstration of aortic valve leaflets held in the fully opened position in diastole by the dissection flap as it prolapsed into the left ventricular outflow tract, dramatically documenting the mechanism of torrential aortic regurgitation in this patient. (ECHOCARDIOGRAPHY, Volume 21, May 2004)