Conventional two-dimensional echocardiography (2DE) has been established as the most widely diagnostic tool in clinical cardiology practice. Its application helps in morphological and functional assessment of cardiac chambers and valves. The advancement in technology of echo machines and its software analysis minimized many difficulties and limitations. However, 2DE application still carries many limitations. It requires mental conceptualization of a series of multiple orthogonal planer or tomographic images into an imaginary multidimensional reconstruction for better understanding of complex intracardiac structures and their spatial relation with surroundings (1). Many of 2DE formula used for volume quantification and ejection fraction calculation especially for left ventricle are based on geometric assumption that may not true providing varied results in the setting of chamber dilatation or distortion and in the presence of regional wall motion abnormalities (2). Interobserver variability for 2DE images interpretation is still due to different ways of data interpolation especially for measurement of mitral and aortic valve orifice area (3,4). These limitations encourage numerous investigators to obviate it by the attempt to obtain three-dimensional images. Three-dimensional echocardiography was developed since more than 15 years provide more accurate assessment of ventricular volume, mass and function and provide a more complete view of the valves. Despite these advantages, it remained a research tool due to many limitations like electrocardiographic and respiratory gating, motion artifacts, time consuming offline analysis and reconstruction. Over the last few years, the advances in transducer and computer software technology led to enhancement of real-time three-dimensional echocardiography (RT3DE) to be applied for clinical utility. The recently developed matrix array transducer consists of approximately 3,000 firing elements improved the contrast resolution and penetration. By this transducer, the entire heart image could be obtained by a pyramidal full-volume acquisition of four cardiac cycles. The development in software made the data off-line analysis faster and easier.

Netherlands Heart Foundation
M.L. Simoons (Maarten) , F.J. ten Cate (Folkert)
Erasmus University Rotterdam
Cardiovascular Research School Erasmus University Rotterdam (COEUR)

Anwar, A. (2009, November 25). New Applications for Real-Time Three-Dimensional Echocardiography. Retrieved from