Accuracy of real-time 3-dimensional echocardiography in the assessment of mitral prolapse. Is transesophageal echocardiography still mandatory?

Gutiérrez‐Chico, Juan Luis; Gómez, José Luis Zamorano; Rodrigo-López, José Luis; Mataix, Luis; Isla, Leopoldo Pérez de; Almería-Valera, Carlos; Aubele, Adalía; Macaya-Miguel, Carlos

doi:10.1016/j.ahj.2007.10.045

Cited by 59 publications

(38 citation statements)

References 18 publications

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“…69 A recent study compared segmental analysis of mitral prolapse from transthoracic RT3DE images against TEE findings and found that these 2 techniques yield similar comparative accuracy for precise anatomic localization of prolapsing mitral valve segments. 70,71 Interestingly, the study by De Castro and colleagues 72 reported higher concordance between 3D TEE and surgery than 2D TEE in the evaluation of prolapsing mitral valve scallops. The diagnostic accuracy of RT3DE evaluation of functional anatomy of mitral regurgitation also was demonstrated recently against surgical findings.…”

Section: Mor-avi Et Almentioning

confidence: 99%

Real-Time 3-Dimensional Echocardiography

2009

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O ne of the most significant developments of the last decade in ultrasound imaging of the heart was the evolution of 3-dimensional (3D) imaging from slow and labor-intense offline reconstruction to real-time volumetric imaging. This imaging modality provides valuable clinical information that empowers echocardiographers with new levels of confidence in the diagnosis of heart disease. We have previously described the technological milestones in the development of real-time 3D echocardiographic (RT3DE) imaging and its major advantages over conventional 2-dimensional echocardiography (2DE) and reviewed the published literature that supported the use of this new methodology in clinical practice. 1 Since 2006, the growing availability of RT3DE technology, its ease of use, and its multiple attractive features have sparked significant interest in the research community, resulting in a large number of publications, most of which have endorsed RT3DE imaging for clinical use by demonstrating its unique capabilities in different scenarios. In parallel, the clinical acceptance of this new tool has broadened significantly. The most recent clinically significant addition is matrix-array transesophageal echocardiography (TEE), which provides images of unprecedented quality that aid surgeons and interventional cardiologists in planning and guiding procedures and evaluating their outcomes.The purpose of the present article is to review the most recent RT3DE literature and provide readers with an update on the latest developments and the current status of this noninvasive imaging tool. Because different potential applications of RT3DE imaging have been explored to various extents, they are described here separately, and each is discussed with an emphasis on the scientifically established facts, along with the known stumbling blocks and difficulties. Quantification of LV Volumes and FunctionA firmly established advantage of 3D imaging over crosssectional slices of the heart is the improvement in the accuracy of the evaluation of left ventricular (LV) volumes and ejection fraction (EF) by eliminating the need for geometric modeling, which is inaccurate in the presence of aneurysms, asymmetrical ventricles, or wall motion abnormalities, and the errors caused by foreshortened views even in symmetrical ventricles. The value of RT3DE imaging in this context has been demonstrated by multiple studies that compared RT3DE volume measurements with widely accepted reference techniques, including radionuclide ventriculography and cardiac magnetic resonance (CMR). [2][3][4][5][6] These studies and others have demonstrated higher levels of agreement between the RT3DE approach and the respective reference technique compared with conventional 2DE methodology. Additionally, RT3DE measurements were found to be more reproducible than 2DE 4,5,7 and, in some studies, even as reproducible as CMR. 8 Interestingly, in a recent study in patients after myocardial infarction (MI), 9 RT3DE-derived LV volumes were more accurate and more reproducible than thos...

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Section: Mor-avi Et Almentioning

confidence: 99%

Real-Time 3-Dimensional Echocardiography

2009

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“…Identifying prolapse of the central scallops had the highest sensitivity and specificity. Therefore, this study suggests transthoracic 3DE is an excellent screening test and invasive TEE may not always need to be performed for assessment of MVP [19]. This finding suggests that echocardiographic laboratories with transthoracic 3D imaging systems should develop protocols to routinely image the mitral valve in 3D when mitral prolapse and MR are observed.…”

Section: Mitral Valve Prolapsementioning

confidence: 76%

Three-Dimensional Echocardiography and Mitral Valve Disease

Chapman

Rahko

2010

Curr Cardiol Rep

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Three-dimensional echocardiography is a growing imaging modality, particularly for the evaluation of mitral valve pathology. Functional anatomy in disease states such as mitral regurgitation and stenosis as well as prosthetic valves can be effectively studied, offering superior knowledge to treating physicians. Additionally, three-dimensional echocardiography has the ability to help guide operative and percutaneous interventions, allowing for improved patient outcomes and advancement of clinical research. Continued experience with three-dimensional echocardiography will further our knowledge of the mitral valve and refine current indications for cardiovascular imaging.

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“…[1][2][3][5][6][7][8][9] Importantly, the identification of commissural lesions has greatly improved with 3D TEE with published sensitivity, specificity and accuracy ranging from 89% to 92%, 95% to 99% and 93% to 97%, respectively. This is higher than the sensitivity (54%-66%), specificity (90% to 95%) and accuracy (82% to 89%) reported with 2D TEE.…”

Section: D Echocardiography Improves Lesion Localization and Quantifmentioning

confidence: 99%

Three-dimensional Echocardiography Is Essential for Intraoperative Assessment of Mitral Regurgitation

Tsang

Lang²

2013

Circulation

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Since its introduction, 3-dimensional (3D) transesophageal echocardiography (TEE) has become widely adopted in operating rooms and cardiac catheterization laboratories worldwide. This is because the matrix-array 3D TEE probe allows acquisition of high-quality 3D images in real time with relatively little training. The rapid adoption of this technology has proven that this innovative imaging modality provides additional clinical information beyond that obtained from 2-dimensional (2D) TEE images. These developments have enabled medical centers to create integrated valve programs in which surgeons, interventionalists, and echocardiographers discuss cases and surgical approaches. Response by McCarthy on p 652In particular, 3D TEE has been proven to be superior to 2D TEE in the assessment of both mitral valve anatomy and mitral regurgitation, promoting its use in the operating room (Table 1). [1][2][3] One reason for this superiority is that 3D TEE allows the mitral valve to be displayed en face in an orientation identical to the surgeon's view of the mitral valve intraoperatively. This surgeon's view greatly facilitates communication with cardiac surgeons because they can easily interpret these images.Here, we argue that the widespread acceptance and use of 3D TEE are attributable to the pivotal role this modality plays in the intraoperative assessment of mitral regurgitation. We believe that 3D TEE of the mitral valve is invaluable not only because of the realistic images it provides but also because it improves: 1) lesion localization, 2) identification of the mechanisms causing mitral regurgitation, 3) quantification of the severity of mitral regurgitation, 4) selection of surgical intervention, 5) the choice of the surgeon whose expertise is best suited to perform the operation, 6) guidance of percutaneous mitral valve procedures, and 7) postoperative assessment. 3D Echocardiography of the Mitral ValveAccurate preoperative assessment of the mitral valve is critical in the surgical management of patients with severe mitral regurgitation. This information determines whether the patient should undergo valve repair or replacement, which has implications in terms of timing of surgery and long-term morbidity and mortality. 4 Traditionally, 2D TEE has been used to evaluate mitral valve anatomy. However, 2D TEE requires manual manipulation of the transducer in the esophagus and various degrees of flexion or anteflexion of the probe to acquire the standard mid-esophageal views and to examine all leaflet scallops. Since 2D TEE only provides single plane images, the entire mitral annulus and leaflets are not displayed in a single en face view, making it difficult to identify specific scallops with precision. As well, because the mitral annulus is saddle shaped, distortions of mitral valve anatomy, mitral annular dilatation, or aortic root enlargement may change the orientation of the ultrasound plane in relation to mitral valve apparatus, resulting in scallop misidentification.

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Accuracy of real-time 3-dimensional echocardiography in the assessment of mitral prolapse. Is transesophageal echocardiography still mandatory?

Cited by 59 publications

References 18 publications

Real-Time 3-Dimensional Echocardiography

Real-Time 3-Dimensional Echocardiography

Three-Dimensional Echocardiography and Mitral Valve Disease

Three-dimensional Echocardiography Is Essential for Intraoperative Assessment of Mitral Regurgitation

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