Valvular heart diseaseReal-Time Three-Dimensional Transesophageal Echocardiography for Assessment of Mitral Valve Functional Anatomy in Patients With Prolapse-Related Regurgitation
Section snippets
Methods
From May 2008 to January 2009, we prospectively enrolled 222 consecutive patients referred to our institute for surgical repair of prolapse-related mitral regurgitation. The inclusion criteria for the study were MV prolapse with related severe mitral regurgitation (effective regurgitant orifice ≥0.4 cm2, vena contracta >7 mm, regurgitant volume >60 ml); a complete transthoracic and transesophageal preoperative echocardiographic study; and surgical MV repair within 1 uneventful week from the
Results
Interpretable RT3D-TEE was feasible in all patients, with optimal (90%) and suboptimal (10%) imaging, although off-line reconstruction, removing artifacts, and/or optimizing the ultrasound gain and the smoothing setting improved the suboptimal quality of the examinations. All RT3D-transesophageal echocardiographic zoom mode studies were suitable for quantitative analysis. However, the full-volume data sets were excluded because of the high incidence (60%) of stitching artifacts during off-line
Discussion
The main finding of the present study was that RT3D-TEE is highly accurate for valve lesion mapping in patients with prolapse-related mitral regurgitation who undergo surgical repair. Furthermore, RT3D-TEE provided a quantitative patient-related analysis to determine the objective diagnosis of prolapse in all MV segments along the standard anteroposterior annular plane, together with the recognition of dominant or secondary prolapse. Using the findings from RT3D-TEE, the ≥5-mm leaflet
Acknowledgment
We thank Michael John, BA, of the Vita-Salute San Raffaele University for the English language revision of our report.
References (29)
- et al.
Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guide-Lines (Writing Committee to revise the 1998 guidelines for the management of patients with valvular heart disease)Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons
J Am Coll Cardiol
(2008) - et al.
Mitral regurgitation
Lancet
(2009) - et al.
Percutaneous mitral repair with the MitraClip systemSafety and midterm durability in the initial EVEREST (Endovascular Valve Edge-to-Edge REpair Study) cohort
J Am Coll Cardiol
(2009) - et al.
Functional assessment of mitral regurgitation by transthoracic echocardiography using standardized imaging planes: diagnostic accuracy and outcome implications
J Am Coll Cardiol
(2005) - et al.
Accurate localization of mitral regurgitant defects using multiplane transesophageal echocardiography
Ann Thorac Surg
(1998) - et al.
Use of real-time 3-dimensional transthoracic echocardiography in the evaluation of mitral valve disease
J Am Soc Echocardiogr
(2006) - et al.
A frame work for systematic characterization of the mitral valve by real-time three-dimensional transesophageal echocardiography
J Am Soc Echocardiogr
(2009) Cardiac valve surgery—the “French correction.”
J Thorac Cardiovasc Surg
(1983)- et al.
Sensitivity, specificity and other diagnostic measures with multiple sites per unit
Contemp Clin Trials
(2005) - et al.
Use of mitral valve repair: analysis of contemporary United States experience reported to the Society of Thoracic Surgeons national Cardiac database
Ann Thorac Surg
(2003)