title: Epicardial real-time 3-dimensional echocardiography with the use of a pediatric transthoracic probe: a technical approach.
abstract: OBJECTIVE
  The aim of the present study was to suggest a simple and comprehensive method for performing real-time 3-dimensional (3D) epicardial echocardiography with a pediatric probe small enough for the surgical field. Intraoperative echocardiography is a necessary tool for planning and performing cardiac surgery. Although epicardial intraoperative echocardiography is intended for few patients, it is a part of an exhaustive approach to intraoperative echocardiography.
  
  
  METHODS
  An observational feasibility study.
  
  
  METHODS
  A community hospital, single-institutional study.
  
  
  METHODS
  Eighty consecutive adult patients undergoing cardiac surgery.
  
  
  METHODS
  All patients were examined with 3D epicardial echocardiography before and after cardiopulmonary bypass; x-plane, live 3D, and 3D full-volume imaging modalities were systematically recorded. Feasibility and acquisition time were assessed. The image quality was evaluated by 3 independent surgeons.
  
  
  RESULTS
  Four sequential positions were determined to achieve a complete 3D heart examination focused on the structure of most interest. Acquisition plus elaboration did not require more than 20 minutes.
  
  
  CONCLUSIONS
  Three-dimensional epicardial echocardiography is feasible, and in the x-plane modality it is quicker than standard epicardial 2-dimensional examination. According to the judgment of independent observers, it provides high-quality and reproducible images, which are particularly valuable for mitral valve repair.
authors.affiliation: Santa Maria dei Battuti Hospital, Piazza dell'Opsedale 1, 35100 Treviso, Italy. vsalandin@ulss.tv.it
authors.forename: Valeria
authors.initials: V
authors.lastname: Salandin
authors.forename: Stefano
authors.initials: S
authors.lastname: De Castro
authors.forename: Elena
authors.initials: E
authors.lastname: Cavarretta
authors.forename: Loris
authors.initials: L
authors.lastname: Salvador
authors.forename: Federica
authors.initials: F
authors.lastname: Papetti
authors.forename: Carlo
authors.initials: C
authors.lastname: Valfrè
authors.forename: Natesa G
authors.initials: NG
authors.lastname: Pandian
mesh_terms: D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging; D002315:Cardiopulmonary Bypass; D003199:Computer Systems; D004311:Double-Blind Method; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D017548:Echocardiography, Transesophageal / Q000379:methods*; D005240:Feasibility Studies; D006801:Humans; D008488:Medical Illustration; D008875:Middle Aged; D008946:Mitral Valve Stenosis / Q000000981:diagnostic imaging; D016343:Monitoring, Intraoperative / Q000295:instrumentation* / Q000379:methods; D010496:Pericardium; D025321:Surgery, Computer-Assisted / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging