Neue echokardiografische Techniken

Zusammenfassung

Unter den wichtigen technischen Neuerungen der pädiatrischen Echokardiografie in den letzten 5 Jahren drängt sich als Quanten-sprung das Verfahren der dreidimensionalen Echtzeit-Echokardiografie (real-time three-dimensional echocardiography [RT3DE]) in den Vordergrund. Sie ermöglicht eine realitätsnahe Darstellung von Morphologie und Bewegung des Herzens mit nahezu beliebigen Betrachtungsvarianten. Hinzu kommt eine verbesserte Funktionsbeurteilung der Ventrikel, insbesondere des geometrisch schwer fassbaren rechten Ventrikels. Die Optionen für die Nachbearbeitung haben sich erweitert. Nach 2½-jährigen eigenen Erfahrungen mit 450 untersuchten Patienten im klinischen Routinebetrieb zeichnen sich wichtige Vorteile für Operationsplanung und Indikationsstel-lung für Operation oder Katheterintervention ab. Anhand von typischen Einzelfällen bzw. Fallgruppen werden sie erläutert. Die RT3DE hat auch die Entwicklung von Trainingssimulatoren für die Echokardiografie ermöglicht. Eine neue Methode der Funktionsdiagnostik mit erheblichem Entwicklungspotenzial ist das Speckle-Tracking-Verfahren, das die Beurteilung des segmentalen Deformations-ablaufs durch die Berechnung von zweidimensionalem Strain (2DS) ermöglicht und von uns vor allem für die Analyse mechanischer Dyssynchronie im Rahmen der kardialen Resynchronisationstherapie eingesetzt wird.

Summary

Real time three-dimensional echocardiography (RT3DE) ranks first among technical innovations in echocardiography during the past 5 years. It allows realistic imaging of cardiac structure and motion in any projections or views. It has improved the evaluation of the ventricles, in particular that of the right ventricle, which had been a problem due to its irregular geometry. Options for post processing have increased. After 2½ years experience with 450 patients examined we believe that important advantages have been achieved, e. g. improved planning of surgery and better differential indication for surgery versus catheter intervention. The progress is illustrated with typical cases or diagnosis groups such as atrial septal defects. RT3DE has also paved the way for simulator based training in echo -cardiography. Speckle tracking-derived two-dimensional strain (2DS) appears as another new promising method of functional diagnostics. Main application in our institution is analysis of mechanical dyssynchrony for indication and monitoring of cardiac resynchronization therapy.

Schlüsselwörter

Dreidimensionale Echtzeit-Echokardiografie - angeborene Herzfehler - zweidimensionale Strain-Echokardiografie - Speckle-Tracking-Verfahren

Keywords

Real-time three-dimensional echocardiography - congenital heart disease - two-dimensional strain - speckle tracking

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