3-D echocardiography reduces examination times and dramatically improves accuracy of the most common diagnostic test for heart function

July 07, 1999

Rush is one of the leading institutions in the world using the new technology

The first fundamental breakthrough in diagnostic ultrasound for the heart in more than a decade -- real-time Volumetric three-dimensional echocardiography -- is now available to instantaneously provide ultrasound scans of the whole heart, rather than a single isolated section.

Rush-Presbyterian-St. Luke's Medical Center, Chicago, is one of only nineteen institutions throughout the world using this technology, and is participating in several national studies to evaluate the use of standard echocardiography versus the new 3-D technology to measure left ventricular function both at rest and with exercise.

In the United States, over 14 million people a year undergo echocardiography. It is the most commonly performed test for heart related illnesses.

3-D echocardiography measures the size of each heart chamber, shows wall motion and scans the entire heart in the time it takes conventional echocardiography to acquire a single, two-dimensional image. While the image of the heart is displayed in two dimensions on a monitor, the computer sees and processes the image of the heart in three dimensions, allowing cardiologists to perform a complete examination of the structure and function of the entire heart from an infinite number of views.

Because the image is more anatomically correct and detailed, physicians are able to make faster, more precise measurements, enhancing the accuracy of their decisions. The additional information aids in determining the degree of heart failure or wall damage. With this information, physicians can determine if the patient's heart would benefit from cardiac bypass surgery, or is strong enough to withstand chemotherapy if the patient needs it to treat cancer. It also can provide more complete structural information to better assess whether a faulty valve could be repaired surgically or must be replaced.

"Valve replacement surgery has been done routinely in the United States since the early 1960s," explains Dr. Verdi DiSesa, chairman of cardiothoracic surgery at Rush. "But patients who have had valve replacement surgery must make significant changes in their lifestyles such as regular blood tests, limiting physical activity and a lifetime of taking anticoagulant drugs. Surgical repair of the valve is an attractive alternative whenever possible, especially for patients who are younger and more active."

In the last decade, the number of valve repairs has grown drastically due to increasingly better quality of echocardiographic technology.

"With 3-D echocardiography, the technology is even more advanced and we have the ability to see a valve in its entirety. With the capability to see the depth and detail, surgeons can assess the damage and determine if repair is an option," said DiSesa.

Cardiologists can actually cut the digital heart displayed on the monitor and get a view of the pumping organ from both the top and bottom. This enables surgeons to perform a mock surgery on the heart before the patient even arrives.

"3-D echocardiography is an exciting new advance in the evolution of cardiac echocardiography," said Dr. James Macioch, associate director of the Rush echocardiography laboratory. "It can dramatically reduce current echocardiography examination time and remove much of the guess work associated with existing two-dimensional ultrasound. The timesaving is especially important in its use with exercise testing: when quick and accurate collection of cardiac images is imperative."

The conventional two-dimensional method, which has been used for the past two decades, cannot accurately measure the volume of an irregularly shaped heart, and often requires multiple images which are time-consuming to acquire since the image is presented one section, or slice, at a time.

In addition to using 3-D echocardiography, a cardiologist can acquire a digital copy of the entire heart in a single beat, eliminating the current, sometimes lengthy process needed to capture the precise image required for diagnosis in two-dimensional echocardiography. Even after the patient has left the laboratory, physicians can access and analyze the exact part of the patients heart needed from the system's memory.

"Three-dimensional echocardiography provides clinicians with more confidence for the diagnosis of cardiac disease and adds insight to the understanding of complex pathology," Macioch said.

3-D echocardiography has been proven valuable in earlier studies for patients with congenital heart disease, coronary artery disease, atrial and ventricular septal defects and mitral and aortic valve disease.

The real-time Volumetric 3-D echocardiographic imaging system, model 1, is manufactured by Volumetrics Medical Imaging, Inc. located in Durham, N.C.
Rush-Presbyterian-St. Luke's Medical Center includes the 809-bed Presbyterian-St. Luke's Hospital; 154-bed Johnston R. Bowman Health Center for the Elderly; Rush University (Rush Medical College, College of Nursing, College of Health Sciences and Graduate College); and seven Rush Institutes providing diagnosis, treatment and research into leading health problems. The medical center is the tertiary hub of the Rush System for Health, a comprehensive healthcare system capable of serving about three million people through its outpatient facilities and eight member hospitals.

Rush University Medical Center

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