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In This Article

  • Summary
  • Abstract
  • Introduction
  • Protocol
  • Representative Results
  • Discussion
  • Acknowledgements
  • Materials
  • References
  • Reprints and Permissions

Summary

Here, we provide a step-by-step acquisition and analysis protocol for the 3D volumetric assessment of the right ventricle, mainly focusing on the practical aspects that maximize the feasibility of this technique.

Abstract

Traditionally, it was believed that the right side of the heart has a minor role in circulation; however, more and more data suggest that right ventricular (RV) function has strong diagnostic and prognostic power in various cardiovascular disorders. Due to its complex morphology and function, assessment of the RV by conventional two-dimensional echocardiography is limited: the everyday clinical practice usually relies on simple linear dimensions and functional measures. Three-dimensional (3D) echocardiography overcame these limitations by providing volumetric quantification of the RV free of geometrical assumptions. Here, we offer a step-by-step guide to obtain and analyze 3D echocardiographic data of the RV using the leading commercially available software. We will quantify 3D RV volumes and ejection fraction. Several technical aspects may help to improve the quality of RV acquisition and analysis as well, which we present in a practical manner. We review the current opportunities and the limiting factors of this method and also highlight the potential applications of 3D RV assessment in current clinical practice.

Introduction

Echocardiography came a long way from its first clinical applications in the 1950s1. The first one-dimensional ultrasound probes were designed to provide simple linear diameters of the chamber walls and lumens; however, they undoubtedly represent a milestone in cardiovascular imaging. The development of two-dimensional (2D) ultrasound imaging was another major step by providing much more precise quantification of morphology and function and is still considered to be the standard method in everyday clinical practice. Nevertheless, 2D echocardiography-based assessment still carries a major limitation of the technique: imaging of a given chamber f....

Protocol

The protocol follows the guidelines of the institution's human research ethics committee and the patients of the clinical cases gave their written informed consent to the study.

1. Technical requirements

  1. For 3D acquisition and analysis, use appropriate software and hardware. Use ECG cables of the echocardiography device; moreover, it is mandatory for the complete 3D acquisition protocol described below.
  2. For 3D acquisition, use a 3D echocardiographic probe and 3D-compa.......

Representative Results

3D analysis of the RV is feasible in a wide variety of cardiovascular diseases. Case 1 is a healthy volunteer with normal ventricular volumes and function (Figure 1). Case 2 is a post-mitral valve repair patient who is a typical example for the conflicting results of conventional 2D assessment: while TAPSE is markedly reduced, the patient does not show any signs of RV dysfunction and a maintained RV global systolic function was confirmed by normal 3D RV EF (<.......

Discussion

3D analysis of the RV represents an important step in everyday cardiology practice. In parallel with the growing interest of the morphology and function of the previously neglected cardiac chamber, these novel solutions provide clinically meaningful information about the right side of the heart. While 3D acquisition has several aspects that markedly differ from 2D echocardiographic imaging, by keeping special attention to the critical points and by using a thorough protocol, 3D RV analysis may progress from a scientific .......

Acknowledgements

Project no. NVKP_16-1–2016-0017 (’National Heart Program’) has been implemented with the support provided from the National Research, Development and Innovation Fund of Hungary, financed under the NVKP_16 funding scheme. The research was financed by the Thematic Excellence Programme (2020-4.1.1.-TKP2020) of the Ministry for Innovation and Technology in Hungary, within the framework of the Therapeutic Development and Bioimaging thematic programmes of the Semmelweis University.

....

Materials

NameCompanyCatalog NumberComments
3V-D/4V-D/4Vc-DGeneral Electricn.a.ultrasound probe
4D Auto RVQGeneral Electricn.a.software for analysis
E9/E95General Electricn.a.ultrasound machine
EchoPac v203General Electricn.a.software for analysis

References

  1. Edler, I., Lindstrom, K. The history of echocardiography. Ultrasound in Medicine and Biology. 30 (12), 1565-1644 (2004).
  2. Ho, S. Y., Nihoyannopoulos, P. Anatomy, echocardiography, and normal right ventricular dimensions.

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