Manual-of-3D-Echocardiography

Manual of 3DEchocardiographyEduardo Casas RojoCovadonga Fernandez-GolnJos Luis ZamoranoEditors123Manual of 3D EchocardiographyEduardo Casas RojoCovadonga Fernandez-GolfinJos Luis ZamoranoEditorsManual of 3DEchocardiographyEditorsEduardo Casas RojoHospital Ramon y CajalMadridSpainCovadonga Fernandez-GolfinHospital Ramon y CajalMadridSpainJos Luis ZamoranoHospital Ramon y CajalMadridSpainISBN 978-3-319-50333-2 ISBN 978-3-319-50335-6 (eBook)DOI 10.1007/978-3-319-50335-6Library of Congress Control Number: 2017935459 Springer International Publishing AG 2017This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part ofthe material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation,broadcasting, reproduction on microfilms or in any other physical way, and transmission or informationstorage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodologynow known or hereafter developed.The use of general descriptive names, registered names, trademarks, service marks, etc. in this publicationdoes not imply, even in the absence of a specific statement, that such names are exempt from the relevantprotective laws and regulations and therefore free for general use.The publisher, the authors and the editors are safe to assume that the advice and information in this bookare believed to be true and accurate at the date of publication. Neither the publisher nor the authors or theeditors give a warranty, express or implied, with respect to the material contained herein or for any errorsor omissions that may have been made.Printed on acid-free paperThis Springer imprint is published by Springer NatureThe registered company is Springer International Publishing AGThe registered company address is: Gewerbestrasse 11, 6330 Cham, SwitzerlandPrologueNo doubt that echocardiography is the cornerstone in the non invasive diagnosis ofcardiovascular diseases. It provides and accurate, fast and easy to access way ofassessing morphology and function of the heart. The continuous evolution of echocar-diography has lead to the appearance of different tools that assess heart morphologyand function in abetter way. One of the most revolutionary evolutions since the begin-ning has been 3D echocardiography. Simply because the heart is a 3D structure andworks as a 3D pump is a potent reason why cardiologist wants to see the heart in 3D.In this book Dr. Eduardo Casas and colleagues tried to make 3D echo very practi-cal. Indeed is a manual that aims to simplify the understanding and application of 3Dechocardiography. The book comprises ten different sections. Starting with thebasics, the minimum knowledge that we need to know before doing a 3D echo isexplained. This section is really practical, avoiding complex terms of physics thatsometimes produces confusions instead of help. We can learn the basic physics, so asthe general rules for transthoracic so as transesophageal 3D echocardiography. Afterthese basic and general aspects, the book starts with a clear clinical approach and tipsand tricks for evaluating valve diseases, LV function and mechanics and the increas-ing use of 3D echo inside the cath lab for structural interventions. All those chaptershave a clear emphasis in practical tutorials. After the routine use of 3D echo the newdevelopments and cutting edge research information is given in the last chapters.Fusion imaging has emerged in cardiology and 3D echo is not apart from this. Finallya real expert in the field covers the use of 3D in congenital heart disease.Dr. Eduardo Casas did an incredible job as main editor of the book. He managedto harmonise the text in an easy way of reading and producing a real practical book.He handled top authors with a lot of clinical experience in 3D echo and managed tocreate a Manual that for sure will help doctors both in training and in clinical appli-cation of this technique. I personally know Dr. Casas since the days he was aCardiology Fellow. He is extremely intelligent and a doer. Once he commits to aproject, he will make it possible independently of the difficulties he encounters onhis way. This book is a good example of this.Madrid, Spain Jos Luis ZamoranovContents1 Physical and Technical Aspects and Overview of3D- Echocardiography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Denisa Muraru and Luigi P. Badano2 General Aspects of Transthoracic 3D-Echo . . . . . . . . . . . . . . . . . . . . .Jos-Julio Jimnez Ncher, Gonzalo Alonso Salinas, andMarina Pascual Izco3 General Aspects of Transesophageal 3D-Echo . . . . . . . . . . . . . . . . . . .14573Ana Garca Martn, Teresa Segura de la Cal, and Cristina Fraile Sanz4 3D-ECHO Protocols for the Diagnosis of Valvular Diseases. . . . . . . . 101Jos Luis Moya Mur and Derly Carlos Becker Filho5 3D-Echo Protocols for Assesing Cardiac Chambers,Volume and Function . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123Alejandra Carbonell San Romn, Roco Hinojar Bayds, andCovadonga Fernndez-Golfn Lobn6 3D-Wall Motion Tracking: Measuring Myocardial Strain with 3D. . . 145Eduardo Casas Rojo7 Guiding Structural Interventions with 3D-Echo . . . . . . . . . . . . . . . . . 167Covadonga Fernndez-Golfn Lobn, Alejandra Carbonell San Romn,and Jos Luis Zamorano8 Fusion of 3D-Echocardiography and Other Imaging Modalities:Hybrid Imaging. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193Eduardo Casas Rojo and Mara Valverde Gmez9 Cardiac Congenital Disease and 3D-Echocardiography . . . . . . . . . . . 211Michael Grattan and Luc MertensIndex. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231viiChapter 1Physical and Technical Aspects and Overviewof 3D- EchocardiographyDenisa Muraru and Luigi P. BadanoIntroductionThe advent of three-dimensional echocardiography (3DE) represented a real break-through in cardiovascular ultrasound. Major advancements in computer and trans-ducer technology allow to acquire 3D data sets with adequate spatial and temporalresolution for assessing the functional anatomy of cardiac structures in most ofcardiac pathologies. Compared to conventional two-dimensional echocardiographic(2DE) imaging, 3DE allows the operator to visualize the cardiac structures fromvirtually any perspective, providing a more anatomically sound and intuitive dis-play, as well as an accurate quantitative evaluation of anatomy and function of heartvalves 1. In addition, 3DE overcomes geometric assumptions and enables an accu-rate quantitative and reproducible evaluation of cardiac chambers 24, thus offer-ing solid elements for patient management. Furthermore, 3DE is the only imagingtechnique based on volumetric scanning able to show moving structures in the beat-ing heart, in contrast to cardiac magnetic resonance (CMR) or cardiac computedtomography (CT), which are based on post-acquisition 3D reconstruction from mul-tiple tomographic images and displaying only 3D rendered snapshots.Data regarding clinical applications of 3DE are burgeoning and gradually captur-ing an established place in the noninvasive clinical assessment of anatomy and func-tion of cardiac structures. Recently, joint European Association of Echocardiographyand American Society of Echocardiography recommendations have been published,aiming to provide clinicians with a systematic approach to 3D image acquisitionand analysis 5 Finally, the recent update of the recommendations for the chamberquantification using echocardiography recommended 3DE for the assessment of theleft (LV) and right ventricular (RV) size and function 6.D. Muraru L.P. Badano ()Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italye-mail: Springer International Publishing AG 2017E. Casas Rojo et al. (eds.), Manual of 3D Echocardiography,DOI 10.1007/978-3-319-50335-6_11()ZElevation2 D. Muraru and L.P. BadanoPhysics of 2D and 3D UltrasoundThe backbone of current 3DE technology is the transducer. A conventional 2Dphased array transducer is composed by 128 piezoelectric elements, electricallyisolated from each other, arranged in a single row (Fig. 1.1, Left). Each ultrasoundwave front is generated by firing individual elements in a specific sequence with adelay in phase with respect to the transmit initiation time. Each element adds andsubtracts pulses in order to generate a single ultrasound wave with a specific direc-tion that constitutes a radially propagating scan line. Since the piezoelectric ele-ments area arranged in a single row, the ultrasound beam can be steered in twodimensions vertical (axial) and lateral (azimuthal) while resolution in the z axis(elevation) is fixed by the thickness of the tomographic slice, which, in turn, isrelated to the vertical dimension of piezoelectric elements.Modern 3DE matrix-array transducers are composed of about 3000 individuallyconnected and simultaneously active (fully sampled) piezoelectric elements withoperating frequencies ranging from 2 to 4 MHz and 5 to 7 MHz for transthoracicand transoesophageal transducers, respectively. To steer the ultrasound beam in 3D,a 3D array of piezoelectric elements needs to be used in the probe, therefore piezo-electric elements are arranged in rows and columns to form of a rectangular grid(matrix configuration) within the transducer (Fig. 1.1, right upper panel). The elec-tronically controlled phasic firing of the elements in that matrix generates a scanAxial(Y)Axial(Y)Azimuthal(X)Azimuthal (X)Fig. 1.1 Two- and three-dimensional transducers. Schematic drawing showing the main charac-teristics of two- (left panel) and three-dimensional (right panel) transducers1 Physical and Technical Aspects and Overview of 3D- Echocardiography 3line that propagates radially (y or axial direction) and can be steered both laterally(x or azimuthal direction) and in elevation (z direction) in order to acquire a volu-metric pyramidal data set (Fig. 1.1, right lower panel). Matrix array probes can alsoprovide real-time multiple simultaneous 2D views, at high frame rate, oriented inpredefined or user-selected plane orientations by activacting multiple lines of piezo-electric elements within the matrix (Fig. 1.2).The main technological breakthrough which allowed manufacturers to developfully sampled matrix transducers has been the miniaturization of electronics thatallowed the development of individual electrical interconnections for every piezo-electric element which could be independently controlled, both in transmission andin reception.Beamforming (or spatial filtering) is a signal processing technique used to pro-duce directionally or spatially selected signals sent or received from arrays of sen-sors. In 2DE, all the electronic components for the beamforming (high-voltagetransmitters, low-noise receivers, analog-to-digital converter, digital controllers,digital delay lines) are inside the system and consume a lot of power (around100 W and 1500 cm2 of personal computer electronics board area). If the samebeamforming approach would have been used for matrix array transducers used inFig. 1.2 Multiplane acquisition using the matrix array transducer. From the left parasternalapproach, the probe can be used to obtain simultaneous long- and short axis views of the left ven-tricle during the same cardiac cycle (right panels). From the apical approach, the probe can be usedto obtain 2 or 3 simultaneous views (left panels). The orientation of the scan planes (shown in theupper diagrams) can be modified by the operator during acquisition to obtain the desired viewSUMSUMSUM4 D. Muraru and L.P. Badano3DE, it would have required around 4 kW power consumption and a huge PC boardarea to accommodate all the needed electronics to control 3000 piezoeletric ele-ments. To reduce both power consumption and the size of the connecting cable,several miniaturized circuit boards are incorporated into the transducer, allowingpartial beamforming to be performed in the probe (Fig. 1.3). This unique circuitdesign results in an active probe which allows microbeamforming of the signalwith low power consumption (1 W) and avoids to connect every piezoelectric ele-ment to the ultrasound machine. The 3000 channel circuit boards within the trans-ducer controls the fine steering by delaying and summing signals within subsectionsof the matrix, known as patches (microbeamforming, Fig. 1.3). A typical patch fora cardiac matrix probe contains approximately 25 piezoelextric elements config-ured in 5 5 matr