Congenital heart disease: wide-field, three-dimensional, and four-dimensional ultrasound imaging.

The next significant advance for cardiovascular ultrasound will be the introduction of clinical three-dimensional (3-D) imaging. With increasing computer power and software and hardware, 3-D ultrasound imaging will become a reality over the next few years. Of all cardiovascular abnormalities, congenital heart disease is one of the most logical entities to lend itself to wide-field and 3-D presentation. Tomographic two-dimensional (2-D) echocardiography has in great part replaced cardiac catheterization as the means of accurately visualizing congenital cardiac defects. However, two distinct limitations exist with current 2-D presentations: (1) limited field of view (ie, 90 degrees sector) and (2) tomographic slices that must be assimilated by the examiner into a 3-D or four-dimensional diagnosis. True 3-D imaging has the ultimate capability of rendering anatomy in a format comparable to looking at the actual cardiac specimen. If electronic rendering were really feasible and of suitable quality, one could envision electronically extracting the heart from a living human and examining abnormalities much as one might examine a cardiac specimen (ie, "electronic vivisection"). This article reviews the state of the art of wide-field and 3-D cardiovascular ultrasound in the assessment of congenital heart disease.