Zusammenfassung
Die transösophageale Echokardiographie (TEE) ermöglicht im Vergleich zur transthorakalen Echokardiographie (TTE) die Akquisition von Bildsequenzen mit besserer räumlicher Auflösung infolge der Verwendung höherer Schallfrequenzen. Dadurch können prinzipiell Morphologie und Funktion vieler kardialer Strukturen in der TEE genauer als in der TTE analysiert werden. In einem dreidimensionalen (3-D-) TEE-Volumendatensatz können zudem standardisierte Schnittebenen eingestellt werden, die eine quantitative Beurteilung der Zielstrukturen zulassen. So können sowohl die Größe als auch die Funktion des linken Ventrikels (LV) objektiv und reproduzierbar ausgemessen werden. Das enddiastolische LV-Volumen und das totale Schlagvolumen des LV bei Klappenerkrankungen sind daher exakt zu bestimmen. Weiterhin können spezielle kardiologische Strukturen, die durch 2‑D-Schnittbilder nicht vollständig zu analysieren sind, durch die 3‑D-TEE komplett evaluiert werden. So ist z. B. im 2‑D-Bild nur die Ausmessung der rechtskoronaren Tasche der Aortenklappe möglich, da nur diese Tasche in der konventionellen Schnittebenendarstellung zentral getroffen wird. In der 3‑D-TEE können durch Nachbearbeitung im 3‑D-Volumendatensatz auch die akoronare und die linkskoronare Tasche in der jeweiligen zentralen Schnittebene ausgewertet werden. Weitere wichtige Strukturen der 3‑D-TEE-Analysen sind das linke Vorhofohr, das interatriale Septum und die Mitralklappe. Die Planimetrie von Klappen- und Regurgitationsöffnungen sowie das Monitoring bei Interventionen zur Behandlung struktureller Herzerkrankungen sind weitere Einsatzbereiche der klinisch etablierten 3‑D-TEE-Diagnostik.
Abstract
In comparison to transthoracic echocardiography (TTE) transesophageal echocardiography (TEE) enables an acquisition of images with better spatial resolution due to the use of higher ultrasound frequencies. Thus, the morphology and function of cardiac structures can principally be analyzed better and more accurately with TEE than with TTE. In addition, using three-dimensional (3D) TEE data sets standardized sectional planes can be constructed by post-processing, which enables quantitative assessment of the target structures. The size and function of the left ventricle can objectively and reproducibly be measured. End diastolic left ventricular volume and total stroke volume of the left ventricle can be accurately determined in patients with heart valve disease. Furthermore, particular cardiac structures that cannot be totally evaluated by two-dimensional (2D) echocardiography, can be completely analyzed by 3D TEE. In 2D images for example, only analyses of the right coronary cusp of the aortic valve are possible because only the center of the right coronary cusp can be visualized using conventional sectional level presentation. Using 3D TEE the non-coronary cusp and the left coronary cusp can also be visualized in the mid-sectional plane by post-processing of the 3D data set. Additional important structures of 3D TEE analysis are the left atrial auricle, the interatrial septum and the mitral valve. Planimetry of valvular and regurgitation orifices as well as the monitoring of interventions for treatment of structural heart diseases are further fields of application of clinically established 3D TEE diagnostics.
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A. Hagendorff, S. Stoebe, D. Jurisch, M. Neef, M. Metze und D. Pfeiffer geben an, dass kein Interessenkonflikt besteht.
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Hagendorff, A., Stoebe, S., Jurisch, D. et al. Neues und Bewährtes in der kardiologischen Diagnostik mithilfe der TEE. Herz 42, 232–240 (2017). https://doi.org/10.1007/s00059-017-4534-9
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DOI: https://doi.org/10.1007/s00059-017-4534-9
Schlüsselwörter
- Transösophageale Echokardiographie
- Transthorakale Echokardiographie
- Volumenbestimmung
- Klappenerkrankungen
- Dreidimensionale Bildgebung