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The inside view

Like the 3-D images that pop off your local movie screen, the way we can look at hearts has come of multi-dimensional age.

Jared Stiver

Jared Stiver, Assistant
Director, THI

Doctors and technologists have used two-dimensional ultrasound imaging to peer at and into the heart, giving them a flat picture. To create a 3-D effect, parallel 2-D ultrasound scans can be combined via computer.

That’s still the standard practice in many hospitals; but in June, 3-D echocardiography came to Community Hospital, both in the operating rooms and in Cardiology Services exam rooms, providing real-time, three-dimensional ultrasound images of a beating heart.

The ultrasound imaging is done two ways. In transthoracic scans, an ultrasound probe is placed on the patient’s chest to view the heart through the rib cage. In transesophageal scans, a narrow probe is passed into the esophagus, or swallowing tube, while the patient is sedated or asleep.

“A 3-D ‘echo’ provides the cardiologist more information to assist in making clinical decisions by producing more accurate, realistic images that enable the doctor to visualize more detail of the structures of the heart,” says Jared Stiver, assistant director, Tyler Heart Institute, Cardiology Services. Earlier this year, the department was accredited by the Intersocietal Commission for the Accreditation of Echocardiography Laboratories (ICAEL), which ensures quality patient care by recognizing the provision of accurate, reproducible cardiac information.

Using 3-D transesophageal echocardiography for heart surgery is most effective with complex mitral value repairs and replacements, says Dr. Matt Fritsch, a Harvard-trained cardiac anesthesiologist. The third dimension allows for better visualization of the anatomy, Fritsch says, and gives the surgeon a clearer picture of how successful the repair was, or if and where there are potential problems.

The mitral valve is the most complex valve and takes the most stress of any of the valves in the heart. It separates the two left-side chambers of the heart: the left ventricle, which is the workhorse that pumps the blood; and the left atrium, which is the reservoir for the blood. Considerable pressure exists between the two chambers, which are separated only by the mitral valve. So if this valve isn’t working properly, the forward flow from the heart is drastically diminished, causing serious problems for the patient.

“Because of the experience of our highly skilled cardiac surgeons, Dr. Vincent Gaudiani and Dr. Gregory Spowart, we do a lot of complex valve repair and replacement at Community Hospital,” Fritsch says. “So it is crucial to provide the best imagery for the most accurate repair. This doesn’t change how they perform the operation, but it gives them a lot more information.”

Work to make these 3-D images possible was in progress for at least 20 years, says Dr. Richard Gray, medical director of Community Hospital’s Tyler Heart Institute.

“Yet, up until recently, there hadn’t been an acceptance of the technology because it didn’t provide the real-time images doctors sought,” Gray says. “In the last two years, systems have been developed that can integrate various images to look like a real moving picture, which resembles a CT image of the heart. But a CT scan is costly and complex, and uses radiation, which an ultrasound does not. Also, ultrasound can be done at the bedside, which is a breakthrough in the area of data processing and image quality.”

The 3-D technology, Gray says, has effectively “changed the picture” of echocardiography.

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