title: Feasibility and clinical impact of live three-dimensional echocardiography in the management of congenital heart disease.
abstract: BACKGROUND
  Precise assessment of congenital heart lesions requires inferential evaluation from multiple two-dimensional echocardiographic images (2DE). The aim of our study was to assess the usefulness of transthoracic live three-dimensional echocardiography (3DE) in the evaluation of congenital heart disease.
  
  
  METHODS
  Eighty-two patients (from 4 months to 31 years, mean age 12 +/- 7.5, 38 males and 44 females), known to have congenital heart lesions, prospectively underwent both 2DE and 3DE. Conventional data acquisition by 2DE and "full volume" 3DE acquisition (apical four chambers, parasternal long and short axes, subcostal windows) were carried out by two independent and blinded operators. Data derived from 3DE were compared to 2DE, and 3DE results were graded into three categories: (A) new findings not seen on 2D echo studies, but not critical to therapeutic decision making; (B) additional anatomic information useful in therapeutic decision making; and (C) information equivalent to 2D echo studies.
  
  
  RESULTS
  Two out of 82 patients (2%) were excluded because of suboptimal 3DE images. In comparison with 2DE studies, 3DE was graded A in 23 patients (29%), B in 28 patients (35%), and C in 29 patients (36%). In the patients with group B results, atrial and ventricular septal defects, endocardial cushion defects, and l-transposition of great vessels were the most represented pathologies in which 3DE aided medical or surgical therapeutic options. While the new findings in group A did not influence therapy, they defined the whole spectrum of abnormalities in those patients. In patients who fell under group C results, 3DE provided a direct realistic display of the pathology detected by 2DE.
  
  
  CONCLUSIONS
  Our study demonstrates that live 3DE, easily performed at the bedside, provides incremental information on patients with a variety of congenital heart lesions. In the clinical scenario, it clarifies the pathology in all its dimensions, particularly in complex lesions with the incremental information having impact on therapeutic decision making.
authors.affiliation: Department of Cardiovascular and Respiratory Sciences, "La Sapienza" University of Rome, Rome, Italy. stefano.decastro@uniroma1.it
authors.forename: Stefano
authors.initials: S
authors.lastname: De Castro
authors.forename: Stefano
authors.initials: S
authors.lastname: Caselli
authors.forename: Federica
authors.initials: F
authors.lastname: Papetti
authors.forename: Flavia
authors.initials: F
authors.lastname: Ventriglia
authors.forename: Arianna
authors.initials: A
authors.lastname: Giardina
authors.forename: Elena
authors.initials: E
authors.lastname: Cavarretta
authors.forename: Emanuele
authors.initials: E
authors.lastname: Di Angelantonio
authors.forename: Andrea
authors.initials: A
authors.lastname: Marcantonio
authors.forename: Florinda D
authors.initials: FD
authors.lastname: Igual Perez
authors.forename: Natesa G
authors.initials: NG
authors.lastname: Pandian
authors.forename: Bruno
authors.initials: B
authors.lastname: Marino
authors.forename: Francesco
authors.initials: F
authors.lastname: Fedele
mesh_terms: D000293:Adolescent; D000328:Adult; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D003657:Decision Making; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D007223:Infant; D008297:Male; D011300:Preoperative Care / Q000379:methods; D011446:Prospective Studies