Evolving Role of Three-Dimensional Echocardiography for Right Ventricle Volume Analysis in Pediatric Heart Disease: Literature Review and Clinical Applications

Accurate knowledge of right ventricle (RV) volumes and ejection fraction is fundamental to providing optimal care for pediatric patients with congenital and acquired heart disease, as well as pulmonary hypertension. Traditionally, these volumes have been measured by cardiac magnetic resonance (CMR) because of its accuracy, reproducibility, and freedom from geometric assumptions. More recently, an increasing number of studies have described the measurement of RV volumes by three-dimensional echocardiography (3DE). In addition, volumes by 3DE have also been used for outcome research studies in congenital heart surgery. Importantly, 3DE acquisitions can be obtained over a small number of cardiac cycles, do not require general anesthesia, and are less costly than CMR. The ease and safety of the 3DE acquisitions allow for serial studies in the same patient. Moreover, the studies can be performed in various locations, including the intensive care unit, catheterization laboratory, and general clinical. Due to these advantages, 3DE is ideal for the serial evaluation of the same patient. Despite these potential advantages, 3DE has not become a standard practice in children with congenital and acquired heart conditions. In this manuscript, we review the literature on the feasibility, reproducibility, and accuracy of 3DE in pediatric patients. In addition, we investigate the advantages and limitations of 3DE in RV quantification and offer a pathway for its potential to become a standard practice in the assessment, planning, and follow-up of congenital and acquired heart disease.