Farhat Mehmood

Quantification of tricuspid regurgitation by live three-dimensional transthoracic echocardiographic measurements of vena contracta area.

We evaluated tricuspid regurgitation (TR) by multiple echocardiographic techniques in 93 consecutive patients who underwent standard two‐dimensional (2D) and live three‐dimensional (3D) transthoracic echocardiography (TTE). TR vena contracta (VC) area was obtained by 3D TTE by systematic and sequential cropping of the acquired 3D TTE dataset. Assessment of VC area by 3D TTE was compared to 2D TTE measurements of the ratio of TR regurgitant jet area to right atrial area (RJA/RAA), RJA alone, VC width, and calculated VC area. VC area from 3D TTE closely correlated with RJA/RAA and RJA alone as determined from 2D TTE measurements. Live 3D TTE color Doppler measurements of VC area can be used for quantitative assessment of TR and offer incremental value for quantification of particularly severe regurgitant lesions.

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.

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 Left Atrial Tumors

This preliminary study demonstrates the superiority of live three‐dimensional transthoracic echocardiography (3D TTE) over two‐dimensional (2D) TTE in the assessment of left atrial (LA) tumors in four patients studied by us (three myxomas, one hemangioma, all subsequently pathologically proven). Because of the unique ability of live 3D TTE to systematically section and view the contents of an intracardiac mass, LA myxomas in the three patients studied could be more confidently diagnosed by noting isolated echolucent areas consistent with hemorrhage/necrosis in the tumor mass. On the other hand, a definite echolucent area was found by 2D TTE in only two of the three patients with myxoma. In the fourth patient with a hemangioma, live 3D TTE showed much more extensive and closely packed echolucencies with little solid tissue as compared to a myxoma consistent with a highly vascularized tumor. In contrast, 2D TTE demonstrated only two isolated echolucencies in the tumor suggesting an erroneous diagnosis of myxoma.

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.

Live Three-Dimensional Transthoracic Echocardiographic Assessment of Ventricular Noncompaction

We present eight adult patients with noncompaction (four with isolated left ventricular noncompaction and four with combined left and right ventricular noncompaction) in whom live three‐dimensional transthoracic echocardiography (3D TTE) demonstrated multiple, prominent myocardial trabeculations, deep intertrabecular recesses communicating with the ventricular cavity, and a typical honeycombing appearance. In the four patients with combined right and left ventricular noncompaction, very extensive trabeculations in the right ventricle were identified, much more than in normal or hypertrophied right ventricles. Five of the eight patients were not definitively identified to have noncompaction on two‐dimensional (2D) TTE, but the diagnosis was made with 3D TTE. These cases demonstrate the potential usefulness of 3D TTE as a supplement to 2D TTE in the assessment of noncompaction.

Live/real time three-dimensional transthoracic echocardiographic assessment of Ebstein's anomaly

We describe our experience in using live/real time three‐dimensional transthoracic echocardiography (3D TTE) in the assessment of five adult patients with Ebsteins anomaly. The technique was found useful in assessing the distribution and extent of tethering of each of the three leaflets of the tricuspid valve (TV) to the underlying right ventricular walls and the ventricular septum. The characteristic bubble‐like appearance resulting from bulging of the non‐tethered areas of the TV leaflets was also well visualized in three dimensions and their size measured. Thus, an estimate of the nontethered or free segments of all three leaflets of the TV could be obtained using this technique. This has important implications when considering these patients for surgical repair of the TV. Visualization of all three leaflets of the TV and their extent of tethering by 3D TTE also made it easier to identify the boundaries of the functioning right ventricular chamber potentially providing a more reliable assessment of its volumes and ejection fraction. Cropping of color Doppler 3D TTE data sets provided en face viewing of the TV regurgitation vena contracta permitting accurate assessment of its shape and size. This has the potential to provide a more accurate quantitative estimation of TV regurgitation severity as compared to two‐dimensional color Doppler. In conclusion, live/real time 3D TTE appears useful in supplementing two‐dimensional echocardiography in more comprehensively assessing the morphologic features of Ebsteins anomaly. (ECHOCARDIOGRAPHY, Volume 22, November 2005)

Usefulness of Live/Real Time Three‐Dimensional Transthoracic Echocardiography in the Identification of Individual Segment/Scallop Prolapse of the Mitral Valve

In this report, we present 34 patients in whom surgical intervention was undertaken for severe mitral insufficiency due to mitral valve prolapse (MVP). Location and severity of MVP and regurgitation were assessed preoperatively by live/real time three‐dimensional transthoracic echocardiography and closely agreed with the surgical findings.

Incremental Value of Live/Real Time Three‐Dimensional Transthoracic Echocardiography in the Assessment of Left Ventricular Thrombi

This is a case series on three adult patients who contain left ventricular (LV) thrombus and the incremental benefits of live/real time three‐dimensional transthoracic echocardiography (3DTTE) in comparison to two‐dimensional transthoracic echocardiography (2DTTE) in evaluating LV thrombi. These cases illustrate that 3DTTE is of additional benefit by demonstrating the following: (1) cropping of a single 3DTTE apical dataset may be enough to provide comprehensive assessment of the LV in a timely manner even without breath holding in a not fully cooperative patient (2) it identifies the exact point of attachment of the thrombus to the left ventricular wall, (3) helps to delineate the absence or presence of focal echolucent areas within thrombi indicative of the presence and extent of clot lysis, which may have potential therapeutic and prognostic implications, and (4) provides more accurate assessment of thrombus mobility which has prognostic indications.

Papillary Fibroelastoma of the Pulmonary Valve: Assessment by Live/Real Time Three‐Dimensional Transthoracic Echocardiography

The differential diagnosis of a cardiac valve mass includes fibroelastoma, myxoma, lipoma, Lambls excrescences, thrombus, and vegetation. Fibroelastomas are extremely rare primary cardiac tumors. Their incidence is 0.00017–0.033% in autopsy series and 0.019% in clinical series identified on echocardiography. Although rare, fibroelastomas are the most common tumors affecting the cardiac valves with aortic, mitral, tricuspid, and pulmonary valves being involved in this order. In the current report we describe a case of pulmonary valve mass in which a confident prospective diagnosis of fibroelastoma could be made utilizing the technique of three‐dimensional transthoracic echocardiography.