Wikipedia

Three-dimensional transesophageal echocardiography

Three-dimensional transesophageal echocardiography (3D TEE) is a cardiac imaging modality that uses ultrasound to generate three-dimensional images of the heart.[1] It combines transesophageal echocardiography (TEE) with real-time volumetric imaging. The technique provides anatomical views of cardiac structures, particularly the valves, septa, and great vessels, without ionizing radiation.[2] 3D TEE is used for guiding structural heart disease interventions and for intraoperative monitoring during cardiac surgery.[3][4][5]

Three-dimensional transesophageal echocardiography
Synonyms3D TEE
PurposeCardiac imaging for structural heart disease evaluation
Test ofHeart structure and function
MeSHD017548

History

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Early three-dimensional echocardiography required offline reconstruction of sequentially acquired two-dimensional images using rotational, or parallel scanning methods.[6]

In the early 1990s, TomTec Imaging Systems introduced a transesophageal transducer with a stepper motor synchronized to the cardiac and respiratory cycles, enabling sequential image acquisition.[7] A 1994 partnership between TomTec and Hewlett-Packard combined HP's multiplane TEE probe with TomTec's reconstruction software to create a commercial rotational 3D acquisition system.[8][9] This rotational approach was the primary 3D TEE method for approximately seven years.[10]

The development of matrix-array transducer technology enabled real-time volumetric imaging.[11]

Clinical applications

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Structural heart disease interventions

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3D TEE is used to guide percutaneous structural heart procedures.[3] For transcatheter edge-to-edge repair, it guides transseptal puncture and device positioning.[12] During transcatheter aortic valve replacement, it provides intraprocedural guidance and assessment of paravalvular leak.[13] In left atrial appendage occlusion, it assesses LAA morphology and guides device placement.[3] For septal defect closure, it provides views of atrial septal defects.[6]

Valvular heart disease

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For the mitral valve, 3D TEE is used to define anatomy, including identifying scallop prolapse.[4][14] The "surgeon's view" from the left atrium is a standard display.[15] For the aortic valve, 3D TEE may be used for planimetry of the valve area.[16]

Other applications

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3D TEE is used intraoperatively to confirm pre-operative diagnoses and assess the results of surgical repair.[4][17] Additionally, 3D TEE is used in assessing congenital heart disease[18] and for measuring ventricular volumes.[1]

Advantages

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3D TEE provides views of valves not available with 2D imaging,[4][10] allows quantification of complex structures,[3] and eliminates geometric assumptions inherent in volume calculations.[1]

Limitations and risks

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Image quality with 3D TEE depends on patient anatomy.[1] Temporal and spatial resolution can be lower than 2D TEE,[5] and the technique requires specific training for interpretation.[5] The procedure carries risks associated with sedation and esophageal intubation, including rare esophageal perforation (approximately 1 in 10,000).[2][19] Contraindications include certain esophageal pathologies.[2]

Training

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Interpretation of 3D TEE requires training beyond standard 2D TEE, as outlined in professional society guidelines.[5][20]

References

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  1. 1 2 3 4 Vegas A, Meineri M (October 2016). "Three-dimensional transesophageal echocardiography: Principles and clinical applications". Annals of Cardiac Anaesthesia. 19 (Supplement): S35–S43. doi:10.4103/0971-9784.192622. PMC 5100241. PMID 27762248.
  2. 1 2 3 "Transesophageal Echocardiogram". www.hopkinsmedicine.org. Johns Hopkins Medicine. 2025-09-15. Retrieved 2026-03-15.
  3. 1 2 3 4 Singh GD, Smith TW, Rogers JH (August 2023). "Three-Dimensional Transesophageal Echocardiography in Percutaneous Catheter-Based Cardiac Interventions". Journal of Clinical Medicine. 12 (17): 5664. doi:10.3390/jcm12175664. PMC 10488384. PMID 37685734.
  4. 1 2 3 4 Grewal J, Mankad S, Freeman WK, Click RL, Suri RM, Abel MD, Oh JK, Pellikka PA, Nesbitt GC, Syed I, Mulvagh SL, Miller FA (January 2009). "Real-time three-dimensional transesophageal echocardiography in the intraoperative assessment of mitral valve disease". Journal of the American Society of Echocardiography. 22 (1): 34–41. doi:10.1016/j.echo.2008.11.008. PMID 19131000.
  5. 1 2 3 4 Faletra FF, Ramamurthi A, Dequarti MC, Leo LA, Moccetti T, Pandian N (July 2023). "Three-dimensional transoesophageal echocardiography: how to use and when to use-a clinical consensus statement from the European Association of Cardiovascular Imaging of the European Society of Cardiology". European Heart Journal. Cardiovascular Imaging. 24 (8): e119–e197. doi:10.1093/ehjci/jead090. PMID 37259019.
  6. 1 2 Handke M, et al. (November 2006). "Transesophageal real-time three-dimensional echocardiography: methods and initial in vitro and human in vivo studies". Journal of the American College of Cardiology. 48 (10): 2070–2076. doi:10.1016/j.jacc.2006.07.048. PMID 17112996.
  7. ↑ Borges AC, Witt C, Bartel T, Müller S, Konertz W, Baumann G (1996). "[Article title needed - appears to be on noninvasive diagnosis of heart tumors]". The Annals of Thoracic Surgery. 61 (?): 1163–1167. doi:10.1016/0003-4975(96)00009-4.
  8. ↑ Kisslo J, et al. (May 2007). "Three-dimensional echocardiography: an historical perspective". Cardiology Clinics. 25 (2): 221–229. doi:10.1016/j.ccl.2007.03.002. PMID 17540201.
  9. ↑ Roelandt JR, et al. (1994). "Ultrasonic dynamic three-dimensional visualization of the heart with a multiplane transesophageal imaging transducer". Journal of the American Society of Echocardiography. 7 (3 Pt 1): 217–229. doi:10.1016/S0894-7317(14)80392-6. PMID 8060639.
  10. 1 2 Houck RC, Cooke JE, Gill EA (October 2006). "Live 3D Echocardiography: A Replacement for Traditional 2D Echocardiography?". AJR. American Journal of Roentgenology. 187 (4). doi:10.2214/AJR.04.0857.
  11. ↑ Lee W, et al. (August 2004). Real-time 3D transesophageal echocardiography. IEEE Symposium on Ultrasonics, 2004. doi:10.1109/ULTSYM.2004.1417837.
  12. ↑ Perk G, Lang RM, Garcia-Fernandez MA, Lodato J, Sugeng L, Lopez J, Knight BP, Messika-Zeitoun D, Shah S, Slater J, Brochet E, Chauvel C, De Castro S, Nanda N, Vannan MA, Kronzon I (August 2009). "Use of real time three-dimensional transesophageal echocardiography in intracardiac catheter based interventions". Journal of the American Society of Echocardiography. 22 (8): 865–882. doi:10.1016/j.echo.2009.04.031. PMID 19647153.
  13. ↑ Khalique OK, Guzzardi DG, Pulerwitz TC, Hahn RT, Nazif TM, Leon MB, George I, Vahl TP, Kodali SK, Bapat VN (May 2024). "3-Dimensional Transesophageal Echocardiography Versus Multidetector Computed Tomography for Aortic Annular Sizing in Transcatheter Aortic Valve Replacement". Journal of the American Society of Echocardiography. 37 (5): 485–496. doi:10.1016/j.echo.2024.02.006. PMID 38431212.
  14. ↑ Sugeng L, Shernan SK, Weinert L, Shook D, Raman J, Jeevanandam V, DuPont F, Fox J, Mor-Avi V, Lang RM (December 2008). "Real-time three-dimensional transesophageal echocardiography in valve disease: comparison with surgical findings and evaluation of prosthetic valves". Journal of the American Society of Echocardiography. 21 (12): 1347–1354. doi:10.1016/j.echo.2008.09.006. PMID 19041584.
  15. ↑ Salcedo EE, Quaife RA, Seres T, Carroll JD (October 2009). "A framework for systematic characterization of the mitral valve by real-time three-dimensional transesophageal echocardiography". Journal of the American Society of Echocardiography. 22 (10): 1087–1099. doi:10.1016/j.echo.2009.07.007. PMID 19801300.
  16. ↑ Lang RM, Addetia K, Narang A, Mor-Avi V (September 2019). "3-Dimensional echocardiography: latest developments and future directions". Journal of Thoracic Disease. 11 (Suppl 15): S1909–S1920. doi:10.21037/jtd.2019.08.09. PMC 6783512. PMID 31632797.
  17. ↑ Hien MD, Rauch H, Lichtenberg A, De Simone R, Weimer M, Ponta OA, Rosendal C (April 2013). "Real-time three-dimensional transesophageal echocardiography: improvements in intraoperative mitral valve imaging". Journal of Cardiothoracic and Vascular Anesthesia. 27 (2): 287–295. doi:10.1053/j.jvca.2012.04.006. PMID 22798535.
  18. ↑ Wong PC, Miller-Hance WC (2014). Transesophageal Echocardiography for Congenital Heart Disease. Springer. doi:10.1007/978-1-84800-064-3. ISBN 978-1-84800-064-3.
  19. ↑ Daniel WG, Erbel R, Kasper W, Visser CA, Engberding R, Sutherland GR, Grube E, Hanrath P, Maisch B, Dennig K (March 1991). "Safety of transesophageal echocardiography. A multicenter survey of 10,419 examinations". Circulation. 83 (3): 817–821. doi:10.1161/01.cir.83.3.817. PMID 1999035.
  20. ↑ Hahn RT, Abraham T, Adams MS, Bruce CJ, Glas KE, Lang RM, Reeves ST, Shanewise JS, Siu SC, Stewart W, Picard MH (September 2013). "Guidelines for performing a comprehensive transesophageal echocardiographic examination: recommendations from the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists". Journal of the American Society of Echocardiography. 26 (9): 921–964. doi:10.1016/j.echo.2013.07.009. PMID 23998692.

Further reading

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  • Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, Flachskampf FA, Foster E, Goldstein SA, Kuznetsova T, Lancellotti P, Muraru D, Picard MH, Rietzschel ER, Rudski L, Spencer KT, Tsang W, Voigt JU (January 2015). "Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging". Journal of the American Society of Echocardiography. 28 (1): 1–39.e14. doi:10.1016/j.echo.2014.10.003. PMID 25559473.
  • Zoghbi WA, Adams D, Bonow RO, Enriquez-Sarano M, Foster E, Grayburn PA, Hahn RT, Han Y, Hung J, Lang RM, Little SH, Shah DJ, Shernan S, Thavendiranathan P, Thomas JD, Weissman NJ (April 2017). "Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation: A Report from the American Society of Echocardiography Developed in Collaboration with the Society for Cardiovascular Magnetic Resonance". Journal of the American Society of Echocardiography. 30 (4): 303–371. doi:10.1016/j.echo.2017.01.007. PMID 28314623.
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