Review of 10 years of practical RT-3DTEE (2010-2020)

Objectives: Background: Real-time three dimensional transesophageal echocardiography or RT-3DTEE, with advances in image processing and display, has increased the availability and utility of TEE to a variety of clinical settings as diagnosis and catheter intervention. Patients & Methods: We study all Patients with RT-3DTEE, presented in MEDIC HCMC from October 2010 to May 2020. Results: From October 2010 to May 2020, in MEDIC HCM, we have already performed 1276 cases ofReal-time 3DTEE: Mitral Stenosis (31%), Atrial Septal Defects (16%) and other diseases of the heart.The display of three dimensional images of 3DTEE providing important information’s to assess the anatomical structures and the severity of diseases prior to perform interventional procedure. Conclusion: Real-time 3DTEE overcomes the limitations of 2DTEE in making diagnosis and guiding the catheter intervention.


Background
The first utilization of a TEE device that promised to have clinical utility was reported in 1976 by Frazin and coworkers,  Instruments: X-MATRIX Philips iE33, X-7 real-time 3D TEE probe.
Acquision mode including Live 3D or narrow sector, Full Volume or wide sector, Zoom or the smallest pyramydal size available for acquisition.

i.
Explain the procedure to the patient.
ii. The patient should not have had any intake of food or drink for at least 4-6 hours.
iii. Oral prostheses should be removed.
iv. The patient should be placed in the left lateral decubitus position.
v. Topical anesthetic and sedation.
vi. Introduce a bite block between the teeth.
vii. The probe is gently passed into the oral cavity over the tongue and guided into the larynx.
viii. The patient should be asked to swallow, the probe is gently introduced into esophagus.
b) Case series report study is applied for this topic.
c) The advantages of 3DTEE in compare with 2DTEE in diagnosis and evaluation of diseases prior to perform interventions.
3D TEE can assess the size of ASD and the circumferential rims to select Patients for Transcatheter closure. Currently we perform ASD closure limited to ASDs less than 30mm and with at least 5mm of circumferential rims (Table 1). all the shunts through IAS (Figure 21-37).            and Full volume. Narrowing the diagnosis down by 2DTEE and then 3DTEE should be and is the target of echocardiographic imaging.

Discussion
Three-Dimensional (3D) TEE is a novel technique that provides excellent images of the mitral valve to assess valve anatomy, evaluate the severity [15]. [6] studied 43 consecutive patients with rheumatic mitral stenosis and found that MVA 3D measurements were significantly lower compare with MVA 2D (mean difference -0.16±0.22cm 2 , p<0,005). In our study we found MVA 3D significantly smaller mean MVA 2D : mean difference= 0,21cm 2 with p<0,001.
The cropping function on 3D TEE ensures that the orifice area is measured in a plane that is at the tip of the mitral valve and perpendicular to the inflow through the valve [12]. Assessment of consequences on the LA and LAA (study LA volume, LAA thrombi) using X-plan function and 3D Zoom should be preferred because it is accurate and strongly related to predicting thromboembolic events and detecting thrombi [15]. Thrombi in LA and LAA were recorded on 24 patients with AF and 4 patient with sinus rhythm in our study results. In the current area, Live 3D TEE is a useful complementary tool in assessing the size, site, and shape of an ASD, its rims and relations with neighboring structures. It is also helpful in confirming the good positioning of a device and identifying the site of any residual shunt next to device closure [11]. We always display a true and face view of the defect from the left atrium so that its dimensions can be accurately measured12. Three dimensional 3D TEE clearly visualizes the shape and the rims in a view only, that previously were obtained only by many consecutive 2D views.
Review of 72 successful cases of ASD device closure demonstrates the size of ASD and its rims were always recorded and measured on the 3D TEE view from the left atrium. Three patients with unsuccessful ASD device closure related to short aortic rim (from 0 to 3mm). Case Endocarditis of pulmonary valve is very rare one, the rough systolis murmur at left sternal border resulted in a false diagnosis of disease as small VSD. Patient then had been sent to our department one year later to practice TTE and TEE because of fever. TTE, 2D TEE then 3D TEE consecutively was done. Vegetation