Taking Command of Three-Dimensional Stitching Artifacts: From an Annoyance to an Easy Tool for Navigating Three-Dimensional Transesophageal Echocardiography

Despite many recent advances in three-dimensional (3D) transesophageal echocardiography (TEE) imagining, the process of orienting 3D TEE images is nonintuitive and uses assumptions based on idealized anatomy. Correlating two-dimensional TEE cross-sectional images to 3D reconstructions remains an additional chal-lenge. In this article, we suggest the repurposing of the stitching artifact generated in 2-beat electrocardiogram-gated 3D TEE as a means of exactly orienting 3D images within a patient's unique anat-omy. We demonstrate the application of this strategy to assess a normal mitral valve to localize scallops of mitral valve prolapse and to visualize typical left atrial appendage two-dimensional cuts in a 3D space. By tak -ing command of stitching artifacts, cardiac imagers can successfully navigate the complex structures of the heart for optimal, individualized echocardiographic views. (J Am Soc Echocardiogr 2023;36:105-10.)

Automated summary

Despite advances in 3D transesophageal echocardiography imaging, orienting and correlating images remains challenging. This article suggests repurposing stitching artifacts in 2-beat electrocardiogram-gated 3D TEE to precisely orient 3D images in a patient's unique anatomy. The technique is demonstrated in assessing a normal mitral valve, localizing mitral valve prolapse scallops, and visualizing left atrial appendage in 3D space. Cardiac imagers can benefit from this method for optimal individualized echocardiographic views.