Real Time Transthoracic Three-Dimensional Echocardiography: How Should it be Applied in the Clinical Setting?

Three dimensional (3D) echocardiography has the potential to provide better anatomic and functional details of cardiac structure and function compared with two-dimensional (2D) echocardiography. Prior 3D techniques used a series of 2D images to reconstruct a 3D dataset. However, this method was greatly limited for widespread clinical application due to long acquisition times, spatial and temporal alignment issues and significant postprocessing times. Real-time three dimensional (RT3D) echocardiography initially developed in the 1990s overcame some of these limitations and achieved a technical breakthrough by using a fully sampled matrix phased array probe. This new generation of RT3D echocar-diography provides excellent image quality, makes the real-time volumetric imaging possible and can measure the heart in arbitrary orientations without geometric assumption and image plane positioning. Presently, RT3D echocardiography appears to evolve from a time-consuming research tool to a clinically applicable diagnostic technique, providing rapid, accurate and supplementary information to conventional 2D echocardiography. The following is a review of the current clinical applications for RT3D echocardiography and where it may be optimally applied in the clinical setting.