Three-dimensional echocardiography in congenital heart disease

Three-dimensional (3D) echocardiography has improved dramatically due to technical advances in probe design and computer processing. Congenital heart disease demands a detailed understanding of the spatial relationships of cardiac structures to plan treatment, making 3D echocardiography highly attractive. Novel projections of cardiac structures can be achieved that are impossible by two-dimensional methods, and high frequency probes are now available to allow better 3D imaging in small children. The introduction of a 3D transoesophageal echo probe has extended the applications to real-time guidance of catheter procedures. All of these developments mean that 3D echocardiography is now an accepted complementary imaging technique to conventional cross-sectional echocardiography in congenital heart disease. In addition to morphology, 3D echocardiography can analyse ventricular volumes and function with fewer geometric assumptions than cross-sectional techniques. Analysis of myocardial motion, including 3D tracking of wall motion, is an emerging technique that may become important, particularly in long-term follow-up of operated congenital heart disease. Normal ranges of ventricular volumes and synchrony remain to be established in children. Further improvements in image processing, including automation of analyses and tailoring of software to ventricles of abnormal shape, may move such techniques from a research setting into more mainstream clinical practice.