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Real-time 3-Dimensional Fetal Echocardiography With an Instantaneous Volume-Rendered Display

Early Description and Pictorial Essay

University of Southern California, Keck School of Medicine, Los Angeles, California USA (M.S., P.W.); and Fetal Diagnostic Center, Pasadena, California USA (G.D.).

Address correspondence and reprint requests to Mark Sklansky, MD, Pediatric Cardiology, MS 34, Childrens Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA 90027 USA. E-mail: msklansky{at}chla.usc.edu.

Objective. Random fetal motion, rapid fetal heart rates, and cumbersome processing algorithms have limited reconstructive approaches to 3-dimensional fetal cardiac imaging. Given the recent development of real-time, instantaneous volume-rendered sonographic displays of volume data, we sought to apply this technology to fetal cardiac imaging. Methods. We obtained 1 to 6 volume data sets on each of 30 fetal hearts referred for formal fetal echocardiography. Each volume data set was acquired over 2 to 8 seconds and stored on the system’s hard drive. Rendered images were subsequently processed to optimize translucency, smoothing, and orientation and cropped to reveal "surgeon’s eye views" of clinically relevant anatomic structures. Qualitative comparison was made with conventional fetal echocardiography for each subject. Results. Volume-rendered displays identified all major abnormalities but failed to identify small ventricular septal defects in 2 patients. Important planes and views not visualized during the actual scans were generated with minimal processing of rendered image displays. Volume-rendered displays tended to have slightly inferior image quality compared with conventional 2-dimensional images. Conclusions. Real-time 3-dimensional echocardiography with instantaneous volume-rendered displays of the fetal heart represents a new approach to fetal cardiac imaging with tremendous clinical potential.

Key Words: congenital heart disease • fetal cardiology • 3-dimensional echocardiography

Abbreviations: CHD, congenital heart disease • 3D, 3-dimensional • 2D, 2-dimensional

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