The utility of real-time transthoracic 3-dimensional echocardiography in congenital heart disease in current clinical practice.

To evaluate the utility of three-dimensional transthoracic echocardiography (3D TTE) in the assessment and management of congenital heart disease (CHD). The use of three-dimensional TTE with both pediatric and adult patients has helped to clarify the cardiac anatomy and hemodynamic physiologic lesions in CHD. However, few practical aspects of 3D TTE have undergone systematic review. A retrospective study of CHD patients from January-December 2022 who underwent 3D TTE was conducted to determine the utility of 3D TTE with respect to answering the primary diagnostic question, adding diagnostic information to 2D imaging, concordance with 2D TTE or cardiac CT, and impact on management. During the study period, 76 CHD patients underwent 3D TTE at a median age of 104 months (IQR 29-175.5). The common cardiac segment under investigation was related to the atrioventricular valve. The mean heart rate was 89 ± 20 BPM. The mean volume rate was 17 ± 5. The single beat acquisition was used in all cases. Sedation use was infrequent (22.67%). Three-dimensional TTE answered the primary diagnostic question and added diagnostic information to 2D TTE imaging in all cases (100%). Additionally, 3D TTE impacted the management of the following: provided guided intervention (3/76, 4%), provided information before cardiac surgery (27/76, 36%), and increased understanding of the cardiac anatomy (76/76, 100%). Three-dimensional TTE can be applied in simple to complex CHD cases, across all age groups, from infants to adults. It provides real-time performance, requires no radiation, and infrequent use of sedation. This study showed that 3D TTE was accurate, answered the diagnostic questions in all cases, and frequently added diagnostic information that impacted management.