3D vs 2D Echocardiography in the Era of Minimally Invasive Surgery

Free online webinar organized by the EACTAIC Educational Committee in collaboration with the Echocardiography Subspecialty Committee

Click here to access the on-demand (available for EACTAIC members)

The 3D vs 2D Echocardiography in the Era of Minimally Invasive Surgery, Rome, Italy, 27/09/2021-27/09/2021 has been accredited by the European Accreditation Council for Continuing Medical Education (EACCME®) with 2 European CME credits (ECMEC®s). Each medical specialist should claim only those hours of credit that he/she actually spent in the educational activity.

Take home message and conclusions by dr. J. Bence (UK)

We learned the following:
1. Language, Acquisition and Conventions of 3D
2. Visualising, identifying and diagnosing pathology
3. Measuring the Valve Dimensions and extent of Pathology
4. Planning the Intervention
5. Practicing the intervention
6. Guiding Interventions
7. Measuring the outcome
8. Identifying Complications

Conclusions

3D Echo Cardiography:
– Improves diagnosis
– Improves Accuracy of Measurements
– Improves Guidance of intervention
– Improves Safety
– Improves our understanding of the heart and valves and pathology
– Is Complementary to all other modalities

What’s in it for me?

After joining this webinar

  • You will become familiar with 3D imaging techniques.
  • You will have an integral understanding of mitral, aortic, and tricuspid heart valves pathology.
  • You will be able to evaluate surgical results during minimally-invasive cardiac valve surgery.
  • You will be able to guide the surgeon in minimally invasive mitral, aortic, and tricuspid heart valves procedures.

Target audience

Cardiac surgeons, cardiologists, cardiovascular anaesthetists, perfusionists, intensivists, general anaesthetists, anaesthesia certified nurses, nurses, interns, and medical students.

Scientific director: Mohamed R. El Tahan, EACTAIC Education chair

Session Chair: J. Bence (UK), Chair of the EACTAIC Echocardiography Subspecialty committee

Moderators: J. van der Maaten (The Netherlands), T. Antoniou (Greece)

1. The additional value of 3D echo over 2D

-  Essential tips on 3D imaging techniques, image acquisition and post processing - M. Meineri (Germany, Canada)
- Where 3D is advantageous over 2D in valve evaluation - D. Tsiapras (Greece)

2. The role of 3D TEE in minimally invasive surgery

- Mitral valve repair - G. Athanasopoulos (Greece)
- Aortic valve replacement surgery - J. van der Maaten (The Netherlands)
- Tricuspid valve annuloplasty - E. Leontiadis (Greece)

Summary of the applications of 3D TEE in minimally invasive surgery - J. Bence (UK)

The size of the aortic annulus is subject to inner pressure and dynamic change during the cardiac cycle.  Therefore,  measurements related to the aortic annulus are measured in mid-systole. In contrast, measurments of the cusps (e.g. area) and  aortic root (sinus of Valsalva, STJ) are measured in diastole.

Speakers:

The effective height between the RCC and the LCC or NCC is the distance from the aortic annulus (the basal ring) to the coaptation point of the free edges of the leaflets, irrespective of the position relative to the centre of the aortic root.

Speakers:

The geometric height can only be measured in diastole by accurate adjustment of perpendicular sectional planes which is only possible by 3D echo.  

Speakers:

Assuming  reference to the free margin length (being twice the measured cusp edge) which approximates the aortic annulus diameter, it is not a measurement that is advised in the guideliens. 

Speakers:

Based on a series of 316 patients who underwent reconstruction of a regurgitant bicuspid AV, the authors showed that apostoperative eH ≥9 mm was associated with very few AV reoperations after 10 years, as opposed to a reoperation rate close to 50% in case of eH <9 mm (Aicher D, Circulation 2011;123:178-85).

Speakers:

It is true that using 2D echo only two cusps each time can be visualized. Only in transgastric view especially when RV is dilated all 3 cusps can be seen as tips. Using 3D TOE as seen in the presentation we can visualize all 3 cusps every time either by atrial view or ventricular view, measure distances perimeter and areas.

Speakers:

3D Imaging still depends on the same US physics 2D does therefore when the primary 2D image is poor the 3D will not be satisfactory.

Speakers:

In this case 2D and 3D Colomust confirm a the presence of a jet.

Speakers:

The American Society of Echocardiography  Guidelines from 2017 include 3D Color in the assessment of EROA. It can be also used for intraoperative decision making in case of Ischemic MR.

Speakers:

Obtaining goob quality 3D images of the TV is certainly more difficlult than for the MV. Using the new X8 2T Probe on a Philips platform we can obtain good quality images in approximately 80% of the cases. We usually start from a oprimized ME RV inflow-outflow view and then use 3D Zoom.

Speakers:

There are research data looking at chordal tension during Neocord implantation with 3D TOE.

Speakers:

The biplane mode is regularly used for clip implantation. 3D is used for perpendicularity interrogation. Previous planning of clip suitability is based on 3D TOE.

Speakers:

Measurements are interchangeable , providing that the prerequisites for the respective analysis have been fulfilled. Do not forget that the quality of 3D imaging is based on 2D imaging quality.

Speakers:

2D in end-diatole in 4 chambers view is recommended, multiplanr reconstruction could be more precise but not recommended currently.

Speakers:

4 chambers view, end-diastole.

Speakers:

3D Deep esophageal view probably better, all 3 leaflets are visualized.

Speakers:

According to current guidelines 21 mm/m2 or 40 mm, in end-diastole is the limit for intervention at the tricuspid valve in patients with tricuspid valve during left-heart disease operation.

Speakers:

The modified bicaval view does not give any additional information to identifying the pathology of the leaflets compared to the bicommissural view or transgastral view  (biplane or 3D) ----Measuring TAPSE, S' for tricuid annulus etc require proper alignment for acquisition which is rather difficult in TEE.

Speakers:

RV focused 4 chamer view with good visualization of the apex and the RVOT would be enough for obtaining RVQ.

Speakers:

Long term survival for repair seems to be better than for replacement. If the bioprosthetic valve fails, then the transcatheter therapy may play a role.

Speakers:

This is also correct, In echocardiography we use the above mentioned measurements.

Speakers:

This modified TAPSE measurement seems correlate well with TAPSE and RV fractional area change.  RV longitudinal strain could give quick and reliable information once validated.

Speakers:

The Mid esophageal 4 chambers view, maybe in the future MPR becomes validated and becomes a more reproducible tool.

The webinar is supported by an unrestricted educational grant by Onassis Cardiac Surgery Center and GE.

The Onassis Cardiac Surgery Center is the premier cardiovascular surgery and interventional cardiology hospital in Greece, certified with ISO 9001:2015. It is a non-profit public welfare institution. The Center was designed, built, equipped and furnished, by the Alexander S. Onassis Public Benefit Foundation.  It provides a complete spectrum of services in cardiac surgery and cardiology for all forms of acquired and congenital heart disease, including heart and lung adult transplantations. Its clinical results are comparable to those of the best centers in Europe and the USA. It is a host center for the Fellowship Programme in Cardiothoracic and Vascular Anesthesia (Fellowship in CTVA) offered by EACTAIC.


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Event Details
  • Start Date
    September 27, 2021 5:00 pm
  • End Date
    September 27, 2021 7:30 pm
  • Status
    Expired
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