Sept 22, 2015 | Tarek Alsaied, MD
Education

As a pediatric cardiology fellow in training (FIT), I recently attended the 2015 American Society of Echocardiography Conference (ASE), which was held in Boston from June 12-16. The ASE Council on Pediatric and Congenital Heart Disease put together a program that was full of cutting edge science and case based learning, which included pathology, echocardiography and surgical discussions on transposition of the great arteries and mitral valve abnormalities with a focus on the role of 3D echocardiography prior to surgery.

Specifically, the conference highlighted the rapid progress of 3D echocardiography techniques, especially with the emergence of high frame rate imaging. In a nutshell 3D echocardiography can be very helpful in evaluating atrioventricular (AV) valves especially in AV canal defect and Ebstein’s anomaly. In atrial septal and ventricular septal defects, 3D echocardiography helps with understanding the extension of the defect and aids the cardiologist in planning further interventions.

There were also many abstracts highlighting 3D printing in congenital heart disease. This new modality allows better understanding of 3D anatomy, especially with complex congenital heart disease. It also allows the surgeon to have a complete 3D model of the heart and perform virtual surgery. Future advances may even allow for 3D printing of living tissues, valves and stents used in congenital heart disease surgery.

The concept of 3D echocardiography and 3D printing fascinates me as a pediatric cardiology FIT. Currently, we receive strong training in 2D echocardiography, which is extremely important and forms our understanding for cardiac anatomy in children. When we think about 2D echocardiography our brains try to create a 3D picture of the heart anatomy, making 3D echocardiography a very helpful tool.

Another emerging technique in echocardiography is strain or deformation imaging. The term strain describes simply lengthening, shortening or thickening, also known as regional deformation. The technique allows for regional wall motion evaluation. In adults, strain imaging has many clinical applications especially in post chemotherapy cardiomyopathy. The reproducibility is still limited and may be limiting the clinical use in children. However, with the advances in echocardiography techniques and software, it is expected that this technique will gain more momentum in pediatric cardiology.

The ACC 2015 Core Cardiovascular Training Statement Task Force 5 emphasized the role of 3D echocardiography in structural heart disease and in planning and guiding certain interventional and surgical procedures. The statement recommends that Level II training in echocardiography prepares fellows to apply 3D echocardiography appropriately and exposes them to basic image acquisition and interpretation.

In pediatric cardiology, the recently published Task Force 2 acknowledged the emergence of 3D echocardiography that has become a commonplace in daily practice. As opposed to adult cardiology, the pediatric cardiology guidelines did not recommend any exposure to 3D echocardiography in pediatric cardiology training. This highlights that we are still at the early stages of this technique. Over the next decade it is expected that this technique will be widely available. Refinements in transducer technology and new software tools will increasingly bring 3D echocardiography into the mainstream¹. Currently there is a collaboration effort between the European Association of Cardiovascular Imaging and ASE to write expert consensus guidelines on 3D echocardiography in congenital heart disease which will also explore some of the training issues associated with this emerging technique.

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This post was authored by Tarek Alsaied, MD, a pediatric fellow in training at Cincinnati Children's Hospital Medical Center in Cincinnati, OH.

Reference

1. Shirali GS. Three dimensional echocardiography in congenital heart defects. Annals of pediatric cardiology 2008;1(1):8-17 doi: 10.4103/0974-2069.41050[published Online First: Epub Date]|.