Two and Three-Dimensional Echocardiography in Primary Mitral Regurgitation: Practical Hints to Optimize the Surgical Planning

Abstract

Primary mitral regurgitation (MR) is the second most common valvular disease, characterized by a high burden in terms of quality of life, morbidity, and mortality. Surgical treatment is considered the best therapeutic strategy for patients with severe MR, especially if they are symptomatic. However, pre-operative echocardiographic evaluation is an essential step not only for surgical candidate selection but also to avoid post-operative complications. Therefore, a strong collaboration between cardiologists and cardiac surgeons is fundamental in this setting. A meticulous pre-operative echocardiographic exam, both with transthoracic or transesophageal echocardiography, followed by a precise report containing anatomical information and parameters should always be performed to optimize surgical planning. Moreover, intraoperative transesophageal evaluation is often required by cardiac surgeons as it may offer additive important information with different hemodynamic conditions. Three-dimensional echocardiography has recently gained higher consideration and availability for the evaluation of MR, providing more insights into mitral valve geometry and MR mechanism. This review paper aims to realize a practical overview on the main use of basic and advanced echocardiography in MR surgical planning and to provide a precise checklist with reference parameters to follow when performing pre-operative echocardiographic exam, in order to aid cardiologists to provide a complete echocardiographic evaluation for MR operation planning from clinical and surgical point-of-view.

3D echocardiography in mitral valve prolapse

“…From 3D color Doppler data set, 3DE allows direct measurement of 3D VCA, without any flow or geometric assumption ( 71 , 74 ). After cutting the 3D volumetric data set to optimize the visualization of the regurgitant jet from the “en-face” view, alignment of planes is manually adjusted to identify the origin of the jet ( 75 ). Specifically, two orthogonal planes ( x and y ) are oriented along the major axis of the regurgitating jet, with the third plane (z) placed perpendicular to the direction of the jet and passing through the cross-sectional area of the VC ( 75 ).…”

“…After cutting the 3D volumetric data set to optimize the visualization of the regurgitant jet from the “en-face” view, alignment of planes is manually adjusted to identify the origin of the jet ( 75 ). Specifically, two orthogonal planes ( x and y ) are oriented along the major axis of the regurgitating jet, with the third plane (z) placed perpendicular to the direction of the jet and passing through the cross-sectional area of the VC ( 75 ). 3D VCA is then measured as a planimetry of the regurgitant orifice area ( 17 ).…”

Novel and conventional echocardiographic parameters for choosing management tactics in patients with degenerative mitral valve diseases

“…3D визуализация МК при ЧП-ЭхоКГ превосходит 2D в идентификации сегментов, в определении точной морфологии и локализации поражений МК, оценке динамических изменений митрального кольца, в оценке распространённости патологического прикрепления кольца, а также в обнаружении расщеплений и перфораций створок [23][24][25][26][27]. 3D ЭхоКГ позволяет дополнительно оценить клапан в плане возможности выполнения реконструктивной операции.…”

“…Установлено, что наличие обширной кальцификации створки или кольца, пролапс передней створки МК, пролапс обеих створок или болезнь Барлоу ставят возможность выполнения реконструкции под сомнение (рис. 2) [21,27,28]. 3D ЧП-ЭхоКГ лучше подходит для оценки периметра и площади митрального кольца, которые необходимы для определения размера кольца или ленты для аннулопластики (рис.…”

“…3). При первичной МН должны быть измерены ширина и высота створки и оценено межтригональное расстояние [21,27].…”