Epicardial Real-Time 3-Dimensional Echocardiography With the Use of a Pediatric Transthoracic Probe: A Technical Approach

• Published in: Journal of cardiothoracic and vascular anesthesia 2010-02, Vol.24 (1), p.43-50
• Main Authors: Salandin, Valeria, MD, De Castro, Stefano, MD, Cavarretta, Elena, MD, Salvador, Loris, MD, Papetti, Federica, MD, Valfrè, Carlo, MD, Pandian, Natesa G., MD
• Format: Article
• Language: English
• Subjects: 3-dimensional echocardiography; Anesthesia & Perioperative Care; Aortic Valve Stenosis - diagnostic imaging; Cardiopulmonary Bypass; Computer Systems; Critical Care; Double-Blind Method; Echocardiography, Three-Dimensional - methods; Echocardiography, Transesophageal - methods; epicardial examination; Feasibility Studies; Humans; intraoperative echocardiography; Medical Illustration; Middle Aged; Mitral Valve Stenosis - diagnostic imaging; Monitoring, Intraoperative - instrumentation; Monitoring, Intraoperative - methods; Pericardium; Surgery, Computer-Assisted - methods; Time Factors; Treatment Outcome; Ventricular Dysfunction, Left - diagnostic imaging
• ISSN: 1053-0770; 1532-8422
• DOI: 10.1053/j.jvca.2009.06.013

Objective The aim of the present study was to suggest a simple and comprehensive method for performing real-time 3-dimensional (3D) epicardial echocardiography with a pediatric probe small enough for the surgical field. Intraoperative echocardiography is a necessary tool for planning and performing cardiac surgery. Although epicardial intraoperative echocardiography is intended for few patients, it is a part of an exhaustive approach to intraoperative echocardiography. Design An observational feasibility study. Setting A community hospital, single-institutional study. Participants Eighty consecutive adult patients undergoing cardiac surgery. Interventions All patients were examined with 3D epicardial echocardiography before and after cardiopulmonary bypass; x-plane, live 3D, and 3D full-volume imaging modalities were systematically recorded. Feasibility and acquisition time were assessed. The image quality was evaluated by 3 independent surgeons. Measurements and Main Results Four sequential positions were determined to achieve a complete 3D heart examination focused on the structure of most interest. Acquisition plus elaboration did not require more than 20 minutes. Conclusions Three-dimensional epicardial echocardiography is feasible, and in the x-plane modality it is quicker than standard epicardial 2-dimensional examination. According to the judgment of independent observers, it provides high-quality and reproducible images, which are particularly valuable for mitral valve repair.