EUROMEDICA  Hanover 6-7  Juni 2008	Advanced methods of diagnosis, treatment and prophylactics
	European Academy of Natural Sciences, Hanover European Scientific Society, Hanover Russian Academy of Natural Sciences, Moscow

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Four-dimensional echocardiography (4DEcho)-real-time three-dimensional echocardiography is a new modern technology for assessment of complex anatomy and morphology of heart. This method is based on novel matrix transducer technology which is capable of rapid real-time three-dimensional acquisition and rendering. 4D-Echo now allows us to visualize the heart and its structure dynamics in a realistic fashion with online volume-rendered reconstruction.

The diagnostic performance of four-dimensional echocardiography is visualization of details of cardiac anatomy in patients with heart diseases.

Objective: To estimate opportunities of a four-dimensional echocardiography (4DEcho) in diagnostics of anatomical, morphological and functional abnormalities in patients with different heart diseases.

Methods: The 4DEcho was used on GE Vivid 7 Dimension with matrix 3V transducer.

Results: 150 patients with congenital heart diseases, 20 patients with valvular diseases were included in this study. We made 35 fetal 4DEcho examinations with congenital heart disease.

Use of 4DEcho at congenital heart diseases has allowed to visualise details of anatomic, morphological and functional abnormalities.

Spectrum of congenital heart diseases was wide: septum defects, atrioventricular channel (AVC), coarctation of aorta, pulmonary stenosis, intra-cardiac mass and other. The 4D diagnostics of septal defects has led to the most exact estimation of their localization, the form, edges.

At AVC three components have been investigated: atrial, ventricular, valvular portions of the channel. The greatest interest was represented by an estimation of atrioventricular valves and subvalvular apparatus: a condition and fastening of leaflets, an arrangement of chords of both portions of the common valve, cleft of leaflets.

4DEcho at coarctation of aorta have allowed to define a level and character of narrowing, hypoplasia of descending aorta, LV geometry, hypertrophy and function.

At pulmonary artery stenosis and right ventricular outflow tract obstruction the type and character of pathology has been appreciated with 4DEcho.

Fetal 4D echocardiography allows to improving of visualization of cardiac structures at congenital heart diseases from 22 to 40 weeks of pregnancy.

The acquire heart diseases were presented defeat of mitral, tricuspid, aortic valves, prosthetic valves. At valvular diseases the details of anatomy and morphology have been investigated. Research of prosthetic valves allows to estimating their conditions and dysfunction.

Intra-cardiac mass (the cases of tumour, thrombus, vegetations at infectious endocarditis) also become more accessible to visualisation.

Estimation of ventricular volume is important for baseline and serial evaluation of abnormal hearts.

The left ventricular volume was calculated by multiplane method. We performed 4DEcho multi-plane quantitative analysis of LV volumes, based on contours drawn from three cross sections of end-systole and end-diastole. According to some researchers, the calculating of LV volumes now is quite an exact method because it is based on geometrical reconstruction in three сut-planes (Zaeidan Z et al.,2003, Van den Bosch A E et al,2005).

Conclusions: 4DEcho allows us in daily practice to diagnose details of anatomy and morphology of heart structures and prosthetic valves, to improve revealing of congenital heart diseases in fetuses. The limitation of method of 4DEcho now is connected with possibilities of equipment. We hope that the improvement of equipment and development of method will lead to its wide application as a routine method.