3 d eco en valvulopatias

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The European Association of Echocardiography

HIGHLIGHTS FROM EUROECHO 2009 :3D ECHOCARDIOGRAPHY

Luigi P. Badano**, MD, FESC

**Dr. Badano has received honoraries and research grants from GEHealthcare, Sorin cardio S.p.A., Actelion, Edwards Lifesciences*No off-label use of device




3D ECHO AT EUROECHO 2009

Thursday 9th, Imaging Campus: 3D Echo and cardiac anatomy x 4

Thursday 9th, DICE Spanih: 3D Echo for guiding cath procedures

Thursday 9th, Special Session: 3D Echo in congenital disease

Friday 10 th, Imaging Campus: 3D Wall Motion Tracking x4

Friday 10th, Main Session: 3D Echo. A new dimension to assess the heart1 Poster Session: 3D Echo is real 3D world

1 oral abstract Session: 3D Echo: a new window to the heart



PROGRESS IN ULTRASOUND TECHNOLOGY2D 3D1D

A-Mode M-Mode

1953 – Edler & Hertz 2002



3D ECHO AT EUROECHO 2009Reliable Assesment of LV Size and Function, by R. Lang

Mean difference SD vs MRIRT3DE 2DE

Jenkins 2004 EDV (ml) -4 9 -54 33

ESV (ml) -3 18 -28 28

EF (%) 0 7 -1 13Caiani 2005 EDV (ml) -4 29 -23 86

ESV (ml) -4 33 -19 60

EF (%) -8 14 +4 16

Jacobs 2006 EDV (ml) -14 17 -23 29ESV (ml) -7 16 -15 24

EF (%) -1 6 1 9



3D ECHO AT EUROECHO 2009Reliable Assesment of LV Mass, by A.S. Gopal



Longitudinal Strain Circumferential Strain

Radial Strain Area Strain

3D ECHO AT EUROECHO 20093D Strain, by H.J. Nesser



1 Apical Full-Volume AcquisitionCalculation Time = 332 ± 79 s Badano LP, et al. Data on file

3D ECHO AT EUROECHO 2009Reliable Assesment of LV Size and Function




Hare JL et al. Heart 2008

3D ECHO AT EUROECHO 2009Clinical Significance of Increased Accuracy, by M Monaghan

2D EF band 2D pts (no) Re-allocationby EF 35%

Re-allocationby EF 40%

≤ 25% 32 2 (6%) 1 (3%)

26-35% 36 14 (39%) 5 (14%)36-40% 13 1 (8%) 7 (54%)

41-45% 10 2 (20%) 5 (50%)

> 45% 129 0 2 (2%)




3D ECHO AT EUROECHO 2009Mitral Valve Disease, by J. Hung

Normal MItral ValveAtrial View

P2 ProlapseAtrial View

Anterior

Leaflet Cleft




Mild MR Moderate MR Severe MR3.6 cm 2 /0.19 cm 2 5.44 cm 2 /0.26 cm 2 6.98 cm 2 /0.37 cm 2

0.27 cm 20.19 cm 2 0.40 cm 2

PISA/EROVC/ERO

3D ECHO AT EUROECHO 2009Quantification of Mitral Regurgitation, by N. De Michelis




Real time 3D is feasible, accurate, and highlyreproducible for assessing Mitral valve area .It has the best agreement with invasivetechnique.

More accurate than 2D area, PHT, or PISA .





3D ECHO AT EUROECHO 2009Aortic Root and Valve Modelling, by M. Vannan



3D ECHO AT EUROECHO 2009Right Ventricular Size and Function, by L. Sugeng




EDV= 77 mlESV= 28 mlRVEF= 64%

3D ECHO AT EUROECHO 2009Right Ventricular Size and Function, by L. Sugeng




3D ECHO AT EUROECHO 2009Tricuspid Valve Disease, by L.P. Badano

Normal Tricuspid ValveVentricularView

Tricuspid Valve StenosisVentricularView

Tricuspid Valve Area= 3.6 cm 2



1= 2.6 cm2= 3,8 cm3= 2.9 cm

1= 2.6 cm

Badano LP, et al. Eur J Echocardiogr 2009

3D ECHO AT EUROECHO 2009Tricuspid Valve Disease, by L.P. Badano



3D ECHO AT EUROECHO 2009Transesophageal 3D Echo by RM Lang




3D ECHO AT EUROECHO 2009Transesophageal 3D Echo by RM Lang

Normal St Jude Mitral Valve Endocarditis on Mitral Valve Prostheses




3D ECHO AT EUROECHO 20093D TEE Guiding Cath Procedures, by JL Zamorano

TAVI

Paraprostheticdevices

ASDclosure

MitralClip




3D ECHO AT EUROECHO 2009Atrial Septal septum, by T. Lopez-Fernandez

Atrial Septal Defect Patent Foramen Ovale



• More accurate and reproducible quantification of LVgeometry and function than 2D;

• Unprecedented opportunity to quantify RV geometryand function;

• New way to assess pathology of valve diseases;

• Accurate and reproducible quantification of valve areain mitral and tricuspid stenosis;

• 3D TEE essential in monitoring interventionalprocedures in the cath lab.

3D ECHO AT EUROECHO 2009Summary

3 d eco en valvulopatias

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