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Correspondence

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^a Congenital Cardiac Centre, Southampton University Hospital Trust, Southampton, United Kingdom
^b University College London, Institute of Child Health, London, United Kingdom
^c Congenital Cardiac Centre, Southampton University Hospital Trust, Southampton, United Kingdom

(Email: joseph.vettukattil{at}suht.swest.nhs.uk).

To the Editor:

Multiplanar review is the technique currently used by our team for analysis of 3-dimensional (3D) echocardiographic data sets, but as far as we know, it is not currently routinely applied, or perhaps not fully understood, by most centers doing 3D echocardiography. The second reference cited by Dragulescu and colleagues [1], in common with most published work on 3D echocardiography, addresses only the possibility of multiple cropping methods and does not address the technique of multiplanar review, on which our experience was based.

We acquired the series of 300 patients analyzed in our report as our initial experience as we were developing the technique [2]. Dragulescu and colleagues raise concerns regarding the role of multiplanar review in changing either the principal diagnosis or surgical management in as many as one-tenth of our cohort. Paradoxically, we submit that a more focused study of selected patients with complex congenital cardiac malformations might well have a significantly higher affect than reported in our series.

We have referred to instances in which the 3D data were acquired retrospectively. In these cases, the 2D echocardiographic data were viewed, and if there was a clinical question that could not be answered from this data alone, then 3D data sets were acquired and analyzed. We believe that standard cross-sectional 2D echocardiography is performed to a very high standard in our center, and all preoperative imaging is reviewed by at least one consultant pediatric cardiologist before discussion at our combined clinical meeting. The decision for suitability or otherwise for biventricular repair is then made jointly and decided on a case-by-case basis. The constraints of our report did not permit full presentation of each case, but we would be very happy to send anonymized images to interested external parties for review. When we say that a biventricular repair was "achieved successfully," we mean that the patient left hospital with a biventricular circuit that functioned well.

To address the concerns of Dragulescu and colleagues [1] about the spatial resolution of the technique, it is necessary to emphasize that although for multiplanar review the 3D data sets are acquired transthoracically, it is then possible to review the images in infinite planes from any chosen aspect.

In some patients, it remains a fact that the spatial resolution of currently available transthoracic 3D images is inadequate for accurate visualization of cardiac morphology. Multiplanar review makes it possible to review these images in anatomically appropriate planes in an attitudinally appropriate manner, thus gaining as much information as possible. This approach has significantly improved our understanding of the 3D images as viewed in more familiar but infinite 2D planes. This is the aspect that was explored in our study.

The best way "conclusively to demonstrate the superiority" and the clinical utility of this technique is to participate in a multicenter study of patients with borderline ventricles who have been palliated along the functionally univentricular route, such as those with isomerism or unbalanced atrioventricular septal defects. A further major advantage of multiplanar review is that the full-volume data set acquired at a center anywhere in the world can independently be analyzed by multiple professionals. We would welcome active participation in such a study from centers that may still have doubts on the utility of multiplanar review.

	References

Top References

 

1. Dragulescu A, Khambadkone S, Sullivan I, Marek J. Does multiplanar review of 3-D data alter clinical management?(letter) Ann Thorac Surg 2009;87:2006-2007.[Free Full Text]
2. Bharucha T, Roman KS, Anderson RH, Vettukattil JJ. Impact of multiplanar review of three-dimensional echocardiographic data on management of congenital heart disease Ann Thorac Surg 2008;86:875-881.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Tara Bharucha Robert H. Anderson Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Bharucha, T. Articles by Vettukattil, J. J. Search for Related Content PubMed Articles by Bharucha, T. Articles by Vettukattil, J. J. Related Collections Related Article