Sailendra Upendram

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 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 thrombus in the innominate veins and superior vena cava utilizing right parasternal and supraclavicular approaches

We report the usefulness of right parasternal and supraclavicular live three‐dimensional transthoracic echocardiography in the delineation and follow‐up of a thrombus involving a catheter placed in superior vena cava for dialysis in an adult patient with chronic renal disease.

Live Three-Dimensional Right Parasternal and Supraclavicular Transthoracic Echocardiographic Examination*

In the present study, we describe the usefulness of the recently developed technique of live three‐dimensional transthoracic echocardiography in the assessment of normal cardiac structures and adjacent vessels using the right parasternal and supraclavicular approaches. Examples of some abnormalities diagnosed from these approaches are also illustrated.