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Page 12 of 15 Rong et al. Vessel Plus 2019;3:18 I http://dx.doi.org/10.20517/2574-1209.2019.007
[56]
suggesting that 3D measurements are not interchangeable with 2D measurements. Bouchez et al. studied
the difference in anterior MV leaflet length as measured by expert and novice imagers. The authors found
there were systematic differences in anterior mitral leaflet length in 2D vs. 3D measurements and between
[57]
beginner vs. expert imager measurements (P < 0.001 and P = 0.005, respectively). Tsang et al. found
both novice and intermediate readers had greater difficulty interpreting 3D images of the MV than 2D. In
contrast, expert readers were very proficient at identifying mitral valve anatomy in 2D and 3D. Hien’s study
looked at the diagnostic accuracy of 2D vs. 3D echo for MV prolapse and found that 3D TEE conferred an
[24]
advantage to both expert and inexperienced echocardiographers . Therefore there is some debate as to the
advantage of 3D echo interpretation and diagnosis among different level imagers. The heterogeneity of the
literature suggests there is a significant learning curve for 3D echo and variation in interpretation regarding
level of expertise. It is important to note that many of the studies conferring benefit of 3D and improved
expert were performed by expert readers and may not be applicable in clinical practice.

CONCLUSION
3D echo use, both in the clinical cardiology and perioperative settings, has increased because of its ability to
add important information to the standard 2D exam and evaluate structures without geometric assumptions.
Both real time 3D TEE and offline quantitative measurements from 3D acquisitions have become integral
for qualitative and quantitative analysis of structures and for surgical and procedural guidance. However,
many of these studies were performed under optimal conditions with expert echocardiographers. The true
advantage of 3D in the everyday clinical setting may be less than reported. The next generation of echo
probes with high temporal resolution, improved parametric modeling, and the emergence of new structural
heart devices will continue to facilitate the use of 3D echo perioperatively and increase diagnostic abilities in
the clinical setting. It is imperative that imaging echocardiographers be familiar with 3D spatial orientation
of intracardiac structures as well as how to perform quantitative analysis.

DECLARATIONS
Authors’ contributions
Conception, design, data acquisition, drafting, critical revising, final approval: Rong LQ, Di Franco A

Availability of data and materials
Not applicable.

Financial support and sponsorship
Rong LQ is supported in part by the Foundation in Anesthesia Education and Research Mentored Clinical
Research training grant.

Conflicts of interest
Both authors declared there are no conflicts of interest.

Ethical approval and consent to participate
Not applicable.

Consent for publication
Not applicable.

Copyright
© The Author(s) 2019.