Ecocardiografia tridimensionale: principi generali ed applicazioni cliniche (con particolare riferimento alle cardiopatie congenite).

Methods of three-dimensional reconstruction of cardiac images and emerging clinical applications are described, with special reference to congenital heart disease. Compared to other techniques providing dynamic three-dimensional visualization of heart structures, echocardiography has advantages of better temporal resolution and minor cost. Current applications include assessment of volumes and global and regional ventricular performance, evaluation of time motion of valves and other dynamic processes together with color-flow images, and dissection of the heart into specific areas of interest, such as atrial septum, mitral inflow and aortic outflow. In complex congenital heart disease, three-dimensional reconstruction provides an interpretation of the mode of atrioventricular and ventriculoarterial connections, with simulations of a "surgeon's view" of the heart. Defects as atrioventricular canal, double inlet left ventricle and tricuspid atresia can be examined in details concerning the architecture of valvar and subvalvar apparatus and presence and importance of ventricular septal defect. Other congenital malformations such as transposition of great arteries, truncus, coarctation syndrome, and double outlet right ventricle can be assessed in regard to interventricular communication and infundibular obstruction. Multiplane transesophageal probes are best suitable to this sort of electronic vivisection, but rotational and linear scanning methods have also given useful images of cardiac structures in children as well as adults. Validation studies are in progress on the reliability of a number of quantitative parameters that can be derived from the three-dimensional data set.