Quantification of cardiac chambers size, geometry and function represent the most frequent indications for an echocardiographic study and are pivotal for patient evaluation and management. Three-dimensional echocardiography (3DE) enables an easier, more accurate and reproducible interpretation of the complex geometry of cardiac chambers, overcoming the intrinsic limitations of conventional two-dimensional echocardiography (2DE). One major advantage of the third dimension is the improvement in the accuracy and reproducibility of chamber volume measurement by eliminating geometric assumptions and errors caused by foreshortened views. This feature render the technique feasible and reliable even in patients with asymmetric or distorted cardiac chambers, paradoxically the subjects in whom an accurate quantification is most needed. The purpose of this review is to analyze the role of 3DE in chamber quantification, emphasizing the incremental benefits of 3DE over conventional 2DE. L’analisi quantitativa delle dimensioni, della forma e della funzione delle camere cardiache rappresenta la più frequente indicazione ad un esame ecocardiografico ed è cruciale per il corretto inquadramento clinico ed il successivo trattamento del paziente. L’ecocardiografia tridimensionale (3DE) consente una più facile, accurata e riproducibile valutazione della complessa geometria delle camere cardiache superando le intrinsiche limitazioni della ecocardiografia bidimensionale (2D). Uno dei maggiori vantaggi del 3DE è l’accuratezza con cui vengono misurati i volumi delle camere cardiache evitando gli errori dovuti alle assunzioni geometriche circa la forma della cavità ed il possibile accorciamento arti fattuale delle sezioni inerenti alla metodica 2D. Queste caratteristiche rendono il 3D una metodica fattibile ed affidabile anche in ventricoli asimmetrici o con geometria distorta, che paradossalmente sono proprio coloro in cui un’accurata valutazione sarebbe maggiormente utile. Lo scopo di questa rassegna è quello di analizzare il ruolo del 3DE nella quantizzazione delle camere cardiache mettendo in evidenza i benefici incrementali del 3DE sul 2DE.
Integrating volumetric rendering with motion in real-time, three-dimensional (3D) echocardiography is the most suitable imaging technique for assessing heart valves. Today, the rapidly advancing 3D technology allows us to perform a virtual ‘dissection’ of the heart intra vitam and to discover unprecedented, realistic views of cardiac valves in just a few minutes. The mitral valve is the cardiac structure easiest to visualize by transthoracic or transoesophageal approach. Three-dimensional echocardiography is able to display the non-planar valve leaflets and annulus, the complex subvalvular apparatus and their spatial relationships with the surrounding structures. The complementary use of 3D colour flow adds data about valve integrity and allows the quantitation of valvular diseases. Accumulating evidence suggests that 3D echocardiography is emerging as the reference technique to assess mitral valve morphology and function and guide valvular procedures of mounting complexity. The purpose of this review is to provide an update on the current clinical applications of 3D echocardiography for assessing mitral valves and to stress the incremental benefits of 3D echocardiography over conventional two-dimensional echocardiography.
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