Three-dimensional Echocardiographic Evaluation of Right Ventricular Volume and Function in Pediatric Patients: Validation of the Technique
Department of Pediatrics, University of Padova, School of Medicine, Padova, Italy.Journal of the American Society of Echocardiography: official publication of the American Society of Echocardiography (Impact Factor: 4.06). 08/2007; 20(8):921-9. DOI: 10.1016/j.echo.2007.01.018
The right ventricle (RV) is the main ventricular chamber in many congenital heart diseases before and after surgical correction, and it is the most important determinant of outcome in postoperative tetralogy of Fallot and other complex malformations. Unfortunately its irregular crescentic shape does not allow the use of the geometric assumption used for the left ventricle. Many methods have been suggested in the literature to overcome this problem, none fully reliable. The introduction of volume-rendered 3-dimensional (3D) reconstruction of echocardiography images provides a tool for the direct measurement of cardiac chambers, not based on geometric assumptions. The aim of this research study was to determine the accuracy of 3D echocardiography (3DE) to measure RV volumes in pediatric patients with secundum atrial septal defects, compared with direct volume measurements performed during the intervention. We performed 3DE study in the operating department, with the patient anesthetized, intubated, and ventilated before the surgical procedure. Sequential 2-dimensional echocardiographic images for subsequent 3D rendering were acquired using an ultrasound machine with a transthoracic 4-MHz rotational or 5-MHz transesophageal omniplane probe; in the last 5 patients a machine was used that was equipped with a 3600-crystal real-time 3D probe. To validate the 3DE measurements, these were compared with the volume of the RV directly measured in the operating department, at the end of the surgical procedure, injecting saline solution through the tricuspid valve, using a graduate syringe. Among 25 pediatric patients enrolled in the study, with an age range of 1 and 14 years (mean 4 years) and a weight range of 8.5 to 57.4 kg (mean 18.6 kg), in 23 a mean of 3 echocardiographic acquisitions were performed and compared with the direct measurement. A close comparison was found between RV volumes measured by 3DE and direct volume measurements (P < .00001). The regression line, shifted toward the y axis, which describes the 3DE volumes, indicated that the echocardiographic measures overestimate the surgical ones. In our study this overestimation had the mean of 9% with values comprised between 3% and 19%. The coefficient of repeatability was 4.79 mL with all the values within this range (2 SD of the mean). We conclude that 3DE provides an accurate measurement of RV volume in pediatric patients with RV volume overload. It is a reliable, noninvasive, and nongeometric method of evaluation of the volume of this chamber, and can be considered a precious tool in the armamentarium of the pediatric cardiologist.
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ABSTRACT: Summary form only given, as follows. A new learning algorithm is presented for a mapping artificial neural network. The algorithm was discovered during experimentation with backpropagation and counterpropagation networks. The backpropagation network has an excellent way of representing the knowledge, but its learning procedure converges very slowly toward the desired solution. On the other hand, the counterpropagation network's learning behavior is very predictable and straightforward, but the knowledge acquired is somewhat deficient. The author uses the same knowledge representation as in the counterpropagation network, but the learning algorithm is modified to overcome the described deficiency
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ABSTRACT: The past three decades have seen echocardiography evolve into a cornerstone of modern cardiac investigation. Gradually, additional ultrasound-based techniques have been invented, investigated, and then integrated. A more recent development in echocardiography is three-dimensional imaging, which has permeated every aspect of traditional cardiac ultrasound. It is more than simply the latest addition to “standard” echocardiography and almost has developed into an independent imaging modality, encompassing gray-scale acquisitions, color Doppler, stress, contrast, and now even transesophageal imaging. Its utility in research has long been established, but more recent investigation has focused on its incorporation into daily clinical practice. This article summarizes the available techniques, puts them in a clinical context, and examines recent research.
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ABSTRACT: The fields of pediatric cardiology and congenital heart disease have experienced considerable progress in the last few years, with advances in new diagnostic and therapeutic techniques that can be applied at all stages of life from the fetus to the adult. This article reviews scientific publications in a number of areas that appeared between August 2007 and September 2008. In developed countries, congenital heart disease is becoming increasingly prevalent in nonpediatric patients, including pregnant women. Actions aimed at preventing coronary heart disease must be started early in infancy and should involve the promotion of a healthy diet and lifestyle. Recent developments in echocardiography include the introduction of three-dimensional echocardiography and of new techniques such as two-dimensional speckle tracking imaging, which can be used for both anatomical and functional investigations in patients with complex heart disease, including a univentricular heart. Progress has also occurred in fetal cardiology, with new data on prognosis and prognostic factors and developments in intrauterine interventions, though indications for these interventions have still to be established. Heart transplantation has become a routine procedure, supplemented in some cases by circulatory support devices. In catheter interventions, new devices have become available for the closure of atrial or ventricular septal defects and patent ductus arteriosus as well as for percutaneous pulmonary valve implantation. Surgery is also advancing, in some cases with hybrid techniques, particularly for the treatment of hypoplastic left heart syndrome. The article ends with a review of publications on cardiomyopathy, myocarditis and the treatment of bacterial endocarditis.
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