Three-Dimensional Echocardiography for the Preoperative Assessment of Patients With Left Ventricular Aneurysm Nina Ajmone Marsan, MD, Jos J.M. Westenberg,

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Date of download: 7/5/2016 Copyright © The American College of Cardiology. All rights reserved. From: Validation of real-time three-dimensional echocardiography.

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Three-Dimensional Echocardiography for the Preoperative Assessment of Patients With Left Ventricular Aneurysm Nina Ajmone Marsan, MD, Jos J.M. Westenberg, PhD, Stijntje D. Roes, MD, PhD, Rutger J. van Bommel, MD, Victoria Delgado, MD, Rob J. van der Geest, PhD, Albert de Roos, MD, PhD, Robert J. Klautz, MD, PhD, Johan C. Reiber, PhD, Jeroen J. Bax, MD, PhD The Annals of Thoracic Surgery Volume 91, Issue 1, Pages 113-121 (January 2011) DOI: 10.1016/j.athoracsur.2010.08.048 Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Schematic example of calculation of sphericity index with (A) real-time three-dimensional echocardiography (RT3DE) and (B) magnetic resonance imaging (MRI) in a patient with left ventricular (LV) aneurysm. The major end-diastolic LV long axis was obtained as the longest distance between the center of the mitral annulus and the endocardial apex, identified by cropping the 3D dataset (A) or by selecting the best slice in the MRI acquisition (B). Sphericity index was calculated by dividing LV end-diastolic volume by the volume of a sphere whose diameter was derived from the LV long axis. The Annals of Thoracic Surgery 2011 91, 113-121DOI: (10.1016/j.athoracsur.2010.08.048) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 An example of real-time three-dimensional echocardiography (RT3DE) assessment of left ventricular (LV) regional thickness. After slicing the 3D dataset into 9 LV short-axes (3 at the basal, 3 at the midventricular, and 3 at the apical level), the endocardial and epicardial contours were traced manually at the end-diastolic frame. (A, B) The traced contours were then used to calculate LV regional thickness according to the standard 16-segment model. (C) The white arrows indicate the septum at midventricular level that most likely contains transmural scar tissue (end-diastolic thickness <6 mm). (D) The LV apical segments are also significantly thinned. The Annals of Thoracic Surgery 2011 91, 113-121DOI: (10.1016/j.athoracsur.2010.08.048) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 An example of real-time three-dimensional echocardiography (RT3DE) assessment of mitral effective regurgitant orifice area. The 3D dataset is manually cropped by an image plane perpendicularly oriented to the jet direction until the narrowest cross-sectional area of the jet. The effective regurgitant orifice area is measured (= 0.26 cm2) by manual planimetry of the color Doppler signal, tilting the image in an “en face” view. The Annals of Thoracic Surgery 2011 91, 113-121DOI: (10.1016/j.athoracsur.2010.08.048) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 A set of magnetic resonance imaging (MRI) short-axis slices at basal, midventricular, and apical level acquired (A) for the assessment of left ventricular (LV) wall thickness, using gradient-echo acquisitions, and (B) for the analysis of myocardial scar, using delayed contrast-enhanced images. In this example, the anteroseptum, the anterior wall, and the apex are significantly thinned and contain transmural scar (arrows). The Annals of Thoracic Surgery 2011 91, 113-121DOI: (10.1016/j.athoracsur.2010.08.048) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Bland-Altman scatter plot of differences (y-axis) in (A) left ventricular (LV) end-diastolic volume (EDV), (B) LV end-systolic volume (ESV), (C) LV ejection fraction (EF), (D) LV sphericity index (SI), and (E) mitral regurgitant volume (Rvol) between real-time three-dimensional echocardiography (RT3DE) and magnetic resonance imaging (MRI), plotted against the average between these techniques (x-axis). The mean bias (solid line) and the 95% limits of agreement (dotted lines) are displayed. The Annals of Thoracic Surgery 2011 91, 113-121DOI: (10.1016/j.athoracsur.2010.08.048) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions