Clinical application of real-time three-dimensional echocardiography in pediatric cardiology; Emphasis on left ventricular function

In children born with congenital heart disease (CHD), decreased ventricular
function is an important predictor for morbidity and mortality. Therefore,
careful monitoring of cardiac function, with the possibility to intervene
therapeutically before heart failure becomes manifest, is essential in children
with CHD. MRI is considered to be the standard for quantification of
ventricular function. However, particularly in the pediatric age group MRI has
important disadvantages like the need for general anaesthesia in order to lay
down still during data-acquisition and the fact that it is not a bedside
imaging technique. Consequently MRI is not practical for routine clinical use.
Bedside measurements of ventricular function can be obtained by M-mode (1D) and
2D-echocardiography (2DE). These measurements are unreliable because they rely
on geometric assumptions that do apply to normal hearts, but often not to
diseased hearts. 3D-Echocardiography (3DE) can overcome these problems, since
the entire left ventricle is imaged, obviating the need for geometric
assumptions. In adults with normal and abnormal hearts, real-time 3DE (RT3DE)
has been shown to be more accurate than 1D/2DE for quantification of
ventricular function and was extensively validated with MRI techniques. The use
of RT3DE for ventricular quantification in children has hardly been
investigated. Only a few small studies in selected pediatric patients have
validated RT3DE measurements of ventricular function with MRI, but none have
tested the clinical applicability of RT3DE for evaluation of ventricular
function in daily practice. The hypothesis is that with the currently
available, dedicated pediatric RT3DE hard- and software, ventricular function
can be assessed in routine practice by RT3DE in pediatric patients with
different kinds of CHD.

The primary aim of this study is to assess the applicability of RT3DE for the
evaluation of left ventricular function in daily clinical practice of a
pediatric cardiology service.

Prospective feasibility study. In addition to the standard 2D echo-protocol,
M-mode, 2D and 3D images will be made in order to measure left ventricular
function. All patients will undergo three echocardiography*s; one before and
twice after intervention. The first two echocardiography*s coincide with
echocardiography*s performed for clinical reasons. Healthy volunteers will
undergo two echocardiography*s, of which the first one will coincide with an
echocardiographic examination performed for diagnostic purposes.

This study will be performed in patients under the age of 18, because the
purpose of this study is to evaluate the clinical application of RT3DE in daily
clinical practise of a pediatric cardiology clinic. The echocardiographic
examinations coincide in the majority with echocardiography*s performed for
diagnostic purposes. Echocardiography is not an invasive examination, doesn*t
bring a burden and ultrasound waves have no vulnerable characteristics and
bring therefore no health risks to the participating persons. The burden for
the participating persons will mainly exist from one extra visit to our out
patient clinic and an extra waiting time (10 minutes) on top of the standard
echocardiographic examination.