Head-to-Head Comparison of Two- and Three-Dimensional Transthoracic and Transesophageal Echocardiography in the Localization of Mitral Valve Prolapse

Pepi, Mauro; Tamborini, Gloria; Maltagliati, Anna; Galli, C.; Sisillo, Erminio; Salvi, Luca; Naliato, Moreno; Porqueddu, Massimo; Parolari, Alessandro; Zanobini, Marco; Alamanni, Francesco

doi:10.1016/j.jacc.2006.02.079

Cited by 206 publications

(104 citation statements)

References 18 publications

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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: Echocardiography Improves Lesion Localization and Quantifmentioning

confidence: 99%

“…This is higher than the sensitivity (54%-66%), specificity (90% to 95%) and accuracy (82% to 89%) reported with 2D TEE. 5 Beyond mitral valve prolapse, 3D TEE is superior in recognizing indentations and clefts, which are grooves separating the posterior mitral valve leaflet scallops with depths that are <50% or >50% of the leaflet lengths, respectively ( Figure 1). 3 During surgical inspection while the heart is flaccid, these clefts and indentations are difficult to identify, especially when the scallops are diseased.…”

Section: Echocardiography Improves Lesion Localization and Quantifmentioning

confidence: 99%

“…In addition, 3D TEE can identify subtle pathology unrecognized on 2D TEE studies such as a mitral valve cleft. 3,5 Overall, the use of 3D TEE can accurately classify the mechanism and origin of mitral regurgitation and thus determine the type of repair and level of surgical expertise required.…”

Section: Echocardiography Helps With Surgical Triagementioning

confidence: 99%

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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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Section: Echocardiography Improves Lesion Localization and Quantifmentioning

confidence: 99%

Section: Echocardiography Improves Lesion Localization and Quantifmentioning

confidence: 99%

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

Tsang

Lang²

2013

Circulation

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“…The complex 3D anatomy of the mitral valve apparatus and the rapid motion of the leaflets make it difficult to understand the abnormal structural relationships of a dysfunctional mitral valve from standard 2D echocardiographic images [2]. Newer technologies including 3D transesophageal echocardiographic (TEE) imaging allow for better imaging of the mitral valve though the process of extracting valve motion from these datasets remains to be fully explored [3,4]. In particular, for biomechanical modeling of the valve, leaflet dimensions, motion trajectories, and locations of chordae tendinae attachment are critical to capturing the leaflet dynamics 3D TEE acquisitions that include the papillary muscles and the entire valve apparatus result in image sequences with temporal resolutions that are much lower than those obtained with 2D echocardiography.…”

Section: Introductionmentioning

confidence: 99%

Increasing temporal resolution of 3D transesophageal ultrasound by rigid body registration of sequential, temporally offset sequences

Contijoch

Fernandez-de-Manuel

Ngo

et al. 2010

2010 IEEE International Symposium on Biomedical Imaging: From Nano to Macro

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A description of mitral valve function requires both an accurate anatomical description of the three-dimensional (3D) structure as well as a description of the leaflets' rapid motion. Current two-dimensional (2D) ultrasound imaging is unable to capture the 3D anatomy and 3D imaging suffers from severely reduced temporal resolution. We present a method to utilize two sequential 3D transesophageal echocardiographic (TEE) ultrasound acquisitions with a temporal delay to créate a dataset that captures the 3D anatomical description of the valve and has a higher temporal resolution. The enhanced dataset should provide better information for modeling the motion of the mitral vale.

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“…[5][6][7] Dieser Übersichtsartikel geht alltagsnah auf die klinische Anwendung der 3DE in der Beurteilung der Mitralklappe sowie auf die technischen Möglichkeiten und Limitationen ein. Auf die 3DE des linken Ventrikels ebenso wie auf eine detaillierte Besprechung der aktuellen Forschungsergebnisse wird bewusst verzichtet.…”

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Dreidimensionale Echokardiographie zur Beurteilung der Mitralklappe

Biaggi¹,

Felix²,

Greutmann³

et al. 2011

Cardiovasc Med

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Using two-dimensional echocardiography, the complex anatomy of the mitral valve needs mental reconstruction into its three-dimensional shape. The power of both transthoracic and transesophageal three-dimensional echocardiography (3DE) lies in its possibility of showing the complex mitral valve anatomy in one single image, as opposed to the mental reconstruction based on multiple two-dimensional images and schematic assumptions. Several 3DE modalities are used in daily life, including real time ("live") modes as wells as postprocessed images. 3DE is of special interest in the evaluation of mitral stenosis, complex mitral valve prolapse and mitral valve prostheses. It has an established role in the perioperative mitral valve assessment during mitral valve surgery as well as during percutaneous mitral valve procedures. Limitations of 3DE are relatively low frame rates, an important learning curve as well as timeconsuming processing. Using two-dimensional echocardiography, the complex anatomy of the mitral valve needs mental reconstruction into its three-dimensional shape. The power of both transthoracic and transesophageal three-dimensional echocardiography (3DE) lies in its possibility of showing the mitral valve anatomy as it is rather than what it is assumed to be. Several 3DE modalities are used in daily life, including real time ('live') modes as wells as post-processed images. 3DE is of special interest in the evaluation of mitral stenosis, complex mitral valve prolapse and mitral valve prostheses. It has an established role in the perioperative mitral valve assessment during mitral valve surgery as well as during percutaneous mitral valve procedures.

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Head-to-Head Comparison of Two- and Three-Dimensional Transthoracic and Transesophageal Echocardiography in the Localization of Mitral Valve Prolapse

Cited by 206 publications

References 18 publications

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

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

Increasing temporal resolution of 3D transesophageal ultrasound by rigid body registration of sequential, temporally offset sequences

Dreidimensionale Echokardiographie zur Beurteilung der Mitralklappe

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