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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

View larger version (55K): [in this window] [in a new window] [Download PPT slide]   Figure 1 (Left) Principle of the transesophageal real-time three-dimensional system. Three groups of 8 transducers each are mounted at an interval of 120° on a rotating cylinder. In axial direction, the groups are dislocated by one third of the transducer spacing relative to one another. Thus 24 sections can be recorded/rotation. The frame rate is defined by the number of rotations of the cylinder per second (maximum 20 Hz). (Right) Prototype of the transesophageal echocardiography probe.

View larger version (39K): [in this window] [in a new window] [Download PPT slide]   Figure 2 (Left) Agar models of the left ventricle and the aorta. The spatial structure is excellently depicted in the transesophageal real-time 3-dimensional echocardiography reconstruction (middle and right).

View larger version (97K): [in this window] [in a new window] [Download PPT slide]   Figure 3 (A) Transesophageal real-time 3-dimensional echocardiography depiction of an Amplatz occluder after opening of the first disc. (B) Amplatz occluder after opening of both discs. (C) Three-dimensional reconstruction of the model of an atrial septum defect. (D) Three-dimensional image after closure of the defect with the Amplatz occluder.

View larger version (110K): [in this window] [in a new window] [Download PPT slide]   Figure 4 Depiction of an 8-pole EPS-catheter in the ventricle model. The position of the catheter is clearly visualized. Thanks to the good image resolution of the transesophageal real-time 3-dimensional echocardiography system, even individual poles can be differentiated.

View larger version (114K): [in this window] [in a new window] [Download PPT slide]   Figure 5 Ventricle model with inflated balloon (white arrows) of a Swan-Ganz catheter (yellow arrows).

View larger version (123K): [in this window] [in a new window] [Download PPT slide]   Figure 6 Three-dimensional reconstruction of an aortic stent in the model aorta with excellent resolution of the stent struts. The equipment setting in this example results in a transparent image of the aorta model so that the position and structure of the stent can be recorded in detail.

View larger version (60K): [in this window] [in a new window] [Download PPT slide]   Figure 7 Impeller pump in the ventricle model. The transesophageal real-time 3-dimensional (3D) echocardiography system enables 2 different types of presentation. (Left) Conventional presentation. (Right) By using stereoscopic goggles, the observer obtains a stereoscopic presentation of the structures examined. The objective of this presentation mode is to facilitate 3D navigation.

View larger version (118K): [in this window] [in a new window] [Download PPT slide]   Figure 8 (A) Individual cut plane of the 3-dimensional (3D) data set (5-chamber view). Fine structures like the atrial septum, leaflets of the mitral valve (MV), and cusps of the aortic valve (AV) are spatially well resolved. The 3D data set comprises multiple parallel cut planes. (B) Left oblique view of ventricles and atria. Interatrial (IAS) and interventricular septum (IVS) can be recognized as well as the free wall of the right atrium (RA) and right ventricle (RV). The MV is closed; the view is directed toward the left ventricular outflow tract. (C) View through the opened AV. Further, the view passes through the RA to the IAS. The closed MV can be seen in the anterior area of the left atrium (LA). (D) Top view of the atria, the atrioventricular valves, and the AV. The view passes through the LA to the IAS. Anterior and posterior mitral leaflets are visible. The fine edges of the cusps are well-resolved in the area of the AV; the sinus of Valsalva are visible in the 3D image. LV = left ventricle; TV = tricuspid valve.