Epicardial Real Time 3D Echocardiography with the Use of a Pediatric Transthoracic Probe: Proposal for a Technical Approach

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. Design: An observational feasibility study. Setting: A community hospital, single-institutional study. Participants: Eighty consecutive adult patients undergoing cardiac surgery. Interventions: 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. Measurements and Main 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 highquality and reproducible images, which are particularly valuable for mitral valve repair.