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Background: Right ventricular (RV) volumetric and functional assessments are both crucial for the management of patients with hypoplastic left heart syndrome (HLHS). 3-dimensional echocardiography (3DE) for volume measurements and 2D speckle-tracking echocardiography (2D-STE) for strain analysis are performed separately. 3D-STE is capable of evaluating those parameters simultaneously and providing principal strain (PS), unifying the concepts of myofiber orientation and contraction into a single, maximal contractile direction. However, the application of 3D-STE to HLHS has not been studied and so became the aim of our study., Methods and results: 64 HLHS patients after Fontan palliation underwent 3D-STE analysis measuring RV end-diastolic volume index (EDVi), ejection fraction (EF), global PS (GPS), global circumferential strain (GCS), and global longitudinal strain (GLS). Volume measurements were compared between 3D-STE and 3DE, and strains were compared between 3D- and 2D-STE. EDVi and EF showed strong correlations between 3D-STE and 3DE (r=0.93 and 0.87, respectively). GCS and GLS showed moderate correlations between 3D- and 2D-STE (r=0.65 and 0.61, respectively). GPS showed highest magnitude and excellent correlation with EF (r=-0.95)., Conclusions: Simultaneous volumetric and functional assessment by 3D-STE was a useful method in this HLHS cohort. PS is a promising parameter for evaluating the RV function of HLHS, which could be useful during longitudinal follow-up.

The usefulness of two-dimensional transthoracic echocardiography (2DTTE) in the assessment of right heart compression and dysfunction produced by pectus excavatum chest wall deformity has been well described in the literature by several investigators. However, there is a paucity of reports describing incremental value of live/real time three-dimensional transthoracic echocardiography (3DTTE) over the two-dimensional technique in the evaluation of right heart function in these patients. We present a severe case of pectus excavatum chest wall deformity in a young male, in whom 3DTTE provided incremental value over standard 2DTTE in assessing compression of the right heart before surgery and marked improvement in right heart function parameters following surgical repair. In addition, an updated summary of salient features of this deformity, including 2D and 3DTTE findings as well as right heart echocardiographic parameters by both 2D and 3DTTE in normal/healthy subjects summarized from the literature have been provided in a tabular form for comparison., (© 2018 Wiley Periodicals, Inc.)

We report a case of a right atrial thrombus traversing a patent foramen ovale into the left atrium, where three-dimensional transesophageal echocardiography provided considerable incremental value over two-dimensional transesophageal echocardiography in its assessment. As well as allowing us to better spatially characterize the thrombus, three-dimensional transesophageal echocardiography provided a more quantitative assessment through estimation of total thrombus burden., (© 2015, Wiley Periodicals, Inc.)

Background: Three-dimensional (3D) strain analysis may help overcome the limitations of Doppler and two-dimensional strain analysis for the left ventricle and become the method of choice for left ventricular (LV) systolic function. The aims of this study were to evaluate the feasibility and reproducibility of LV global 3D systolic strain by real-time 3D speckle-tracking echocardiography (STE) in children and to establish their maturational growth patterns and normal values., Methods: A prospective study was conducted in 256 consecutive healthy subjects using real-time 3D echocardiography. Full-volume 3D data were acquired using a 3D matrix-array transducer. Three-dimensional LV peak systolic global strain (GS), global longitudinal strain (GLS), global radial strain (GRS), and global circumferential strain (GCS) values were determined using real-time 3D STE., Results: A total of 228 patients (89%) met the criteria for analysis; 28 (11%) were excluded. The correlations between age and strain variables by real-time 3D STE were poor (R(2) = 0.01-0.05, P < .05). The differences in GLS and GCS among the five age groups were statistically significant but clinically irrelevant. There were no statistical differences in GRS and GS values among the age groups, nor were there statistical differences between the genders for all 3D strain parameters. Intraobserver and interobserver variability ranged from 5.0 ± 4.3% to 10.1 ± 8.5% versus 6.9 ± 6.1% to 17.0 ± 16.2% for coefficients of variation, respectively. Interclass correlation coefficients ranged from 0.78 to 0.87 and from 0.75 to 0.79 for intraobserver and interobserver measurements for GS, GLS, GCS, and GRS, respectively., Conclusions: LV global 3D systolic strain analysis using the new 3D STE is feasible and reproducible in the pediatric population. There are small maturational changes in GLS and GCS, but not in GRS and GS, that are statistically significant but probably clinically irrelevant. Further investigation is warranted for potential clinical application of this new technology in a pediatric population., (Copyright © 2013 American Society of Echocardiography. Published by Mosby, Inc. All rights reserved.)

Background: Myocardial strain is useful in the evaluation of left ventricular function using high-frame rate two-dimensional (2D) speckle-tracking echocardiography (STE). Three-dimensional (3D) STE allows 3D measurement of myocardial deformation, which is potentially more accurate, because it is not affected by through-plane motion. However, the low frame rates of 3D STE are a potential limitation that has not been studied to date. Whereas with 2D STE, high frame rates are necessary because speckles may move out of the imaging plane, it was hypothesized that because they always remain within the scan volume, they should be tracked with 3D STE, even if frame rates are considerably lower., Methods: Twenty-seven subjects were studied, including 16 normal volunteers and 11 patients with nonischemic dilated cardiomyopathy, who underwent 2D (frame rate, 62 ± 9 frames/sec) and 3D echocardiographic imaging. In normal subjects, 3D imaging was performed at four different frame rates, achieved by varying the number of beats used for full-volume acquisition (six, four, two, and one). In the patients with dilated cardiomyopathy, 3D imaging was performed using a four-beat acquisition. The principal components of strain and the corresponding strain rates were calculated in 16 myocardial segments and averaged. Both 2D and 3D images were analyzed using TomTec software to avoid analysis-related differences., Results: In normal subjects, strain and strain rate values were the same for 3D STE with six-beat and four-beat full-volume data sets, corresponding to 25 and 18 frames/sec, respectively. In contrast, 3D STE with one-beat and two-beat data sets, corresponding to 5 and 10 frames/sec, respectively, resulted in significantly lower values. Strain and strain rate values derived from six-beat and four-beat 3D data sets were not significantly lower than 2D STE-derived values, indicating that there was no loss of information due to lower frame rates. In patients with dilated cardiomyopathy, both 2D STE-derived and 3D STE-derived strain values were significantly reduced compared with normal hearts. The differences between 2D STE-derived and 3D STE-derived strain values echoed those noted in the normal subjects., Conclusions: Three-dimensional speckle-tracking echocardiographic assessment of myocardial deformation is not compromised by low frame rates when derived from 18 or 25 frames/sec data sets but is underestimated with lower frame rates., (Copyright © 2012 American Society of Echocardiography. Published by Mosby, Inc. All rights reserved.)

Background: Measurement of right ventricular (RV) volumes and ejection fraction (EF) by two-dimensional echocardiography has limited accuracy and reproducibility because of the complex RV geometry., Objectives: This study sought to validate real-time three-dimensional echocardiography (RT3DE) using a disk summation method for assessment of RV volumes and RVEF in children by comparing it with magnetic resonance imaging (MRI) measurements., Methods: A total of 20 children (mean age 10.6 +/- 2.8 years) were studied. Transthoracic RT3DE was performed using a RT3DE system to acquire full-volume RT3DE data sets from apical windows and data were processed offline using a software package. RV end-systolic volume and end-diastolic volume (EDV) were measured using a disk summation method by manually tracing the endocardial borders. RVEF was calculated as: RVEF = (EDV - end-systolic volume)/EDV x 100%. All participants also underwent MRI studies for comparison of RV indexes., Results: Of the 20 children, 3 were excluded because of poor or incomplete RV images (two RT3DE and one MRI study). For the remaining 17 children, good correlation and agreement between RT3DE and MRI were found (RVEDV: r = 0.98, P < .001, mean difference = -7.0 +/- 9.0 mL, P < .01; RV end-systolic volume: r = 0.96, P < .001, mean difference = -3.2 +/- 7.1 mL, P > .05; RVEF: r = 0.89, P < .001, mean difference = -0.3 +/- 7.1%, P > .05). The intraobserver and the interobserver variabilities ranged from -1.1% to 5.8%., Conclusion: Measurement of RV volumes and EF by RT3DE is feasible, accurate, and reproducible in children compared with MRI measurements.

Background: We sought to assess the accuracy and reproducibility of an automated real-time (RT) 3-dimensional (3D) Doppler echocardiography (RT3DDE) technique for measuring volumetric flow (VF) in children., Methods: A total of 19 healthy children (age = 11.5 +/- 3.5 years) were studied to measure VF through mitral valve (MV), aortic valve (AV), pulmonary valve (PV), and tricuspid valve (TV) by RT3DDE. RT 3D echocardiography was also performed to measure left ventricular (LV) end-systolic volume, LV end-diastolic volume, and stroke volume (stroke volume = LV end-diastolic volume--LV end-systolic volume), which served as a reference standard for comparison with VF by RT3DDE., Results: Compared with stroke volume by RT 3D echocardiography, the correlation with VF was excellent for MV (r = 0.91), good for AV (r = 0.89) and PV (r = 0.89), but poor for TV (r = 0.20) by RT3DDE. There were good agreements for AV (bias = 0.9 +/- 5.0 mL), PV (bias = -0.4 +/- 5.7 mL), and MV (bias = 4.1 +/- 4.7 mL), and marked underestimation for TV (bias = -24.4 +/- 14.6 mL)., Conclusions: Our data demonstrated that VF measurement by RT3DDE is feasible and reasonably accurate for MV, AV, and PV but problematic for TV.

Three-dimensional echocardiography (3DE) has made a dramatic transition from predominantly a research tool to a technology useful in everyday clinical practice. This article outlines the history of 3DE from its beginnings to the most current technology.