Modern TEE technology has progressed from 2D multiplane images to real-time 3D displays of the heart. The 3D probes provide a pyramidal scanning sector (volume). There are different 3D imaging modalities used to assess cardiac anatomy (real-time, zoom, and full-volume, usually gated to ECG signal to construct an imaging dataset over multiple cardiac cycles). The 3D images can be further modified by cropping in any plane to investigate details in morphology.

3D TEE is useful for intraoperative assessment of valvular and ventricular function. Relative to 2D imaging, intraoperative assessment of the MV and AV with 3D TEE is associated with more precise assessment of leaflet pathology, more accurate measurements of valve dimensions and orifice areas, and better correlation with surgical findings. Left ventricular assessments include volume and regional wall motion. After identification of the left ventricular walls and apex from two orthogonal 2D views, a 3D model of the heart is created using endocardial border tracking. Stroke volume and ejection fraction can be automatically calculated. However, 3D echocardiography can only be combined with color, not spectral, Doppler ultrasound, and is subject to all limitations that apply to 2D echocardiography.

References

• Otto CM. Specialized echocardiography applications. In: Otto CM, ed. Textbook of Clinical Echocardiography. 6th ed. Elsevier; 2018:96-119.
• Rong LQ. An update on intraoperative three-dimensional transesophageal echocardiography. J Thorac Dis. 2017;9:S271-S282.