Three-dimensional echocardiography: a new paradigm shift

Significant advances in three-dimensional echocardiography (3DE) have made this modality a powerful diagnostic tool in the cardiology clinic. It can provide accurate and reliable measurements of chamber size and function. In addition, 3DE offers novel views and comprehensive anatomic definition of valvular and congenital abnormalities by rendering 3D contoured images of the structures. It is also useful in monitoring the effectiveness of surgical or percutaneous transcatheter interventions. With demonstrations of efficacy in various clinical settings, 3DE has become a complementary part of the routine diagnostic armamentarium. However, 3DE is regarded as simply a tool for 3D volume or image rendering. If we confine the role of 3DE to this, it will remain a complementary tool to two-dimensional echocardiography (2DE) in the future. Three-dimensional echocardiography has roles beyond 3D volume or image rendering. Three-dimensional echocardiography can acquire a full volume dataset in a single shot, and with combined use of the multiplanar reconstructive mode, it can provide anatomically well-defined 2D planes from the full volume dataset. Hence, by omitting routine 2DE work, 3DE may save time for image acquisition and allow more precise and reproducible review or measurement. Taking this perspective into account, 3DE can be a suitable modality for use as a substitute for 2DE in daily practice. With further advances of 3DE and development of a unified review system capable of display and geometrical assessment of 2D as well as 3D images, 3DE will represent a new paradigm shift in echocardiographic examination in the future.