3DE Assessment of the Pathological Spectrum of Mitral Prosthesis and Sewing Ring Dysfunction: Incremental Value over 2DE

Abstract

Mechanisms of prosthetic valve dysfunction include sewing ring dehiscence, thrombosis, mechanical occluder malfunction, and bioprosthesis degeneration. Accurate diagnosis of prosthetic valve dysfunction can be challenging with 2D echocardiography and may require careful scanning of the prosthesis and its bed in multiple conventional and off-axis views. With 3D transesophageal echocardiography (TEE), enface views of the entire prosthesis and its bed can be obtained from a single acoustic window and the images closely simulate reality in a format that is readily appreciated by interventional cardiologists and cardiac surgeons. 3DTEE has thus emerged as the imaging tool of choice for the diagnosis and assessment of a spectrum of prosthetic valve dysfunction. In particular, 3DTEE has been found to be superior to 2DTEE for the diagnosis of prosthetic valve dehiscence including accurate localization of periprosthetic leaks (PPL), and for assessment of PPL defect anatomy, shape and size all of which are important considerations for potential transcatheter closure.