This website aims to develop an international portal for
learning the complex and dynamic morphology of the congenitally malformed heart through discussion and interaction. The main focus of this site is to focus on the clinical appliaction of advanced cardiac imaging in the assessment of myocardial function and morphology.
Three dimensional echocardiography: (3DE, sometimes also referred to as 4DE when the dimension of time is taken into consideration) is a unique method of visualizing the true and dynamic morphology of the heart. This technique is not just a way of displaying moving images of the heart in 3D. 3DE incorporates a core of biometric data set frozen in time, like the iris photography or finger prints. This enables the cardiologist to bring the frozen heart to life and to dissect it, time and time again. One can compare pre and postoperative anatomy and learn from mistakes. It is also possible to share the data electronically between professionals simultaneously. The fourth dimension is added when the images incorporate moving cardiac structures over one or more cardiac cycles.
MPR: The most important aspect of 3dimensional echocardiography is the potential to slice the dynamic cardiac structures in infinite planes through the three dimensions. This method of analysing the anatomy is termed Multiplanar Reformating or Multiplane Review (MPR). I improvised this technique by moving the planes of dissection, in anatomically appropriate planes throughout the cardiac cycle to define accurately the underlying pathology from which the 3D morphology is reconstructed. This technique is most useful in assessing complex congenital heart defects. It is also helpful to understand the anatomy when resolution of the images are poor and a visually useful 3D image cannot be reconstructed. It marks a transitional phase between 2D and 3D imging within the restrictions of current image resolution.
Please take some time to explore
the website. Individual heart defects are discussed under heart defects. For further details of the techinques please also refer to Heart 2012;98:79-88. Please feel free to contact if you have any comments, questions or would like to upload any of your images for discussion.
The image below is from a 9 year old boy with pulmonary atresia and intact septum. He had RF perforation of the pulmonary valve in the neonatal period. Ssubsequently he undervent Cavopulmonay Anastomosis. Later he had RV overhaul and a 17mm pulmonary contegra graft placement in the RVOT. However, recently he developed deep desaturation with exercise. He also has bilateral femoral vein oclusion. A planned Hybrid PFO closure was abandoned due to the unusual atrial morphology as shown below.
PFO POUCH
The video begins from the right atrial view, The roof of the RA is blind ending as the SVC is detached from it. The atrial septum is well demonstrated with the limbus of the fossa ovalis and the oval fossa defect. When the image is rotated to view from the Left Atrial (LA) side, the aorta is seen anteriorly. Below the left atrial aspect of the aorta is a walled pouch into which the Oval fossa defect is opening. Wall of the pouch is partial, formed by the extension of attachment of the primum septum, seperating it from the left pulmonary veins (seen opening into the LA). Attempt close the defect without knowing 3Dimensional morphology may lead to inappropriate intervention, distorsion of the device due to incomplete opening or other serious complications.
