Principles of Three-Dimensional Ultrasound

Advances in computer and transducer technology have allowed the implementation of three-dimensional echocardiography (3DE) in routine clinical practice, with significant impact on patient diagnosis, management, and outcome. 3DE now offers faster and easier data acquisition, superior image quality, immediate display of cardiac structures, and the possibility of online quantitative analysis of heart valves and cardiac chambers. In comparison with two-dimensional echocardiography used for cardiac chamber quantification, 3DE offers the advantage of enabling the measurement of chamber volumes without any geometric assumptions about their shape or errors due to apical view foreshortening. Moreover, 3DE offers a more realistic anatomic and surgical display of heart valves and congenital defects, allowing a better appreciation of the complex morphologic abnormalities and a superior understanding of the functional interaction among neighboring structures in vivo. As interventional and surgical procedures have become more prevalent for treating structural heart disease, transesophageal 3DE has become a valuable imaging technique for patient selection, intra-procedural guidance and detection of potential complications. Undoubtedly, 3DE will rapidly expand its clinical applications and use across echocardiography laboratories in the next years, and progressively emerge as the primary technique of assessing cardiac and valve function by ultrasound.