Real-time three-dimensional echocardiography: still a research tool or an imaging technique ready for daily routine practice? A pilot feasibility study in a tertiary cardiology centre

Background: The majority of studies demonstrating the diagnostic potential of three-dimensional (3D) echocardiography have been conducted on selected series of patients in research laboratories.Aim: To investigate the feasibility and usefulness of real-time 3D transthoracic echocardiography (RT 3D TTE) in daily routine practice.Methods: The study group consisted of 35 consecutive patients referred to our echocardiographic laboratory. All subjects underwent standard 2D TTE and RT 3D TTE with the use of a commercially available ultrasound system (Sonos 7500, Philips Medical Systems). The quality of 3D acquisitions and post-processed images was graded as: insufficient, satisfactory, good or demo.Results: 3D TTE of the study group yielded 298 acquisitions. 87,2% of acquisitions required post-processing. The quality of 3D datasets was graded as insufficient in 8,0%, satisfactory in 31,4%, good in 37,2% and demo in 23,4% of all acquisitions and reconstructions. Mean time required for 3D TTE, including post-processing, was 12 minutes. 3D reconstructions were particularly helpful in patients with valvular disease or prostheses (n=13), enabling detailed qualitative analysis of leaflets morphology and mobility. In cases of mitral valve prolapse (n=4) 3D TTE allowed identification of the prolapsing scallops. 3D color Doppler flow mapping enabled complete visualization of the regurgitant jets. "En face" reconstructions of atrial septal defects (n=2) facilitated assessment of the morphology of the defects and the tissue rims. In patients with cardiac pacemaker (n=4) 3D TTE allowed excellent visualization of the ventricular lead along with its tip. In patients with ischemic heart disease (n=14) 3D TTE failed to provide additional, clinically relevant information.Conclusions: RT 3D TTE may be used in clinical settings with high feasibility rate and provides additional, clinically relevant qualitative information. The lack of on-board quantitative analysis tools is the main limitation of the currently available system