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CLINICAL RESEARCH: THREE-DIMENSIONAL ECHOCARDIOGRAPHY

Transesophageal Real-Time Three-Dimensional Echocardiography

Methods and Initial In Vitro and Human In Vivo Studies

Michael Handke, MD^_*,_*, Gudrun Heinrichs^_*, Urs Moser, PhD, Felix Hirt, PhD^,1, Felix Margadant, Felix Gattiker, PhD^||, Christoph Bode, MD^_* and Annette Geibel, MD^_*

^_* Department of Cardiology and Angiology, University Hospital Freiburg, Freiburg, Germany
University and ETH Zurich, Institute of Biomedical Engineering, Zurich, Switzerland
Sulzer Markets and Technology AG–Sulzer Innotec, Winterthur, Switzerland
^|| EMPA–Materials, Science & Technology, Dubendorf, Switzerland
University of Sydney, Electron Microscopy Unit, Sydney, Australia

Manuscript received March 15, 2006; revised manuscript received April 27, 2006, accepted May 3, 2006.

^_* Reprint requests and correspondence: Dr. Michael Handke, University Hospital Basel, Department of Cardiology, Petersgraben 4, 4031 Basel, Switzerland. (Email: MHandke{at}uhbs.ch).

OBJECTIVES: The purpose of this study was to develop a transesophageal probe that: 1) enables on-line representation of the spatial structures of the heart, and 2) enables navigation of medical instruments.

BACKGROUND: Whereas transthoracic real-time 3-dimensional (3D) echocardiography could recently be implemented, there is still no corresponding transesophageal system. Transesophageal real-time 3D echocardiography would have great potential for numerous clinical applications, such as navigation of catheters.

METHODS: The newly developed real-time 3D system is based on a transesophageal probe in which multiple transducers are arranged in an interlaced pattern on a rotating cylinder. This enables continuous recording of a large echo volume of 70 mm in length and a sector angle of 120°. The presentation of the volume-reconstructed data is made with a time lag of <100 ms. The frame rate is up to 20 Hz. In addition to conventional imaging, the observer can obtain a stereoscopic image of the structures examined with red/blue goggles.

RESULTS: It was shown in vitro on ventricle- and aorta-form agar models and in vivo that the system enables excellent visualization of the 3D structures. Shape, spatial orientation, and the navigation of various catheters (e.g., EPS-catheter, Swan-Ganz-catheter), stents, or atrial septal defect occluders could be recorded on-line and stereoscopically depicted. The size of the echo sector enables a wide field of view without changing the position of the probe.

CONCLUSIONS: Transesophageal real-time 3D echocardiography can be technically realized with the system presented here. The in vitro and in vivo studies show particularly the potential for navigation in the heart and large vessels on the basis of stereoscopic images.

Abbreviations and Acronyms   3D = 3-dimensional   ASD = atrial septal defect   RT3DE = real-time 3D echocardiography   RT3D-TEE = transesophageal real-time 3D echocardiography   TEE = transesophageal echocardiography