How to Implement Three-Dimensional Echocardiography in the Routine of the Echocardiography Laboratory

Abstract

The advent of three-dimensional echocardiography (3DE) represented a real breakthrough in cardiovascular ultrasound. Major advancements in computer and transducer technology allow to acquire 3D data sets with adequate spatial and temporal resolution for assessing the functional anatomy of cardiac structures in most of cardiac pathologies. Compared to conventional twodimensional echocardiographic (2DE) imaging, 3DE allows the operator to visualize the cardiac structures from virtually any perspective, providing a more anatomically sound and intuitive display, as well as an accurate quantitative evaluation of anatomy and function of heart valves. In addition, 3DE overcomes geometric assumptions and enables an accurate quantitative and reproducible evaluation of cardiac chambers, thus offering solid elements for patient management. Furthermore, 3DE is the only imaging technique based on volumetric scanning able to show moving structures in the beating heart, in contrast to cardiac magnetic resonance (CMR) or cardiac computed tomography (CT), which are based on post-acquisition 3D reconstruction from multiple tomographic images and displaying only 3D rendered snapshots. Data regarding clinical applications of 3DE are burgeoning and gradually capturing an established place in the noninvasive clinical assessment of anatomy and function of cardiac structures. Recently, joint European Association of Echocardiography and American Society of Echocardiography recommendations have been published, aiming to provide clinicians with a systematic approach to 3D image acquisition and analysis. Finally, the recent update of the recommendations for the chamber quantification using echocardiography recommended 3DE for the assessment of the left and right ventricular size and function. However, despite all these evidences 3DE has not yet been adopted for the clinical routine in most echocardiography laboratories. This chapter tries too identify the bareers that have hampered the diffusion of 3DE in the clinical arena and to offer some practical advices on how to implement 3DE in the clinical practice.