Clinical InvestigationValvular Heart DiseaseQuantification of Mitral Valve Anatomy by Three-Dimensional Transesophageal Echocardiography in Mitral Valve Prolapse Predicts Surgical Anatomy and the Complexity of Mitral Valve Repair
Section snippets
Study Population
From October 2009 to November 2010, we prospectively enrolled 50 consecutive patients with severe MR due to MVP who underwent elective surgical MV repair at Toronto General Hospital (Toronto, ON, Canada). For patients without previous TEE (n = 17), study TEE was performed at our echocardiography laboratory. For patients with preoperative TEE performed at external institutions (n = 33), TEE was performed in the operating room. All patients underwent postoperative 2D transthoracic
Study Population
The study population consisted of 50 patients with a mean age of 61 ± 11 years (Table 1). The average 3D full-volume frame rate was 29.6 ± 8.4 Hz. The quality of the 3D full-volume data sets was insufficient for MV quantification in four patients, but qualitative MVP assessment remained feasible using the 3D zoom data sets.
Surgical Findings and Type of Surgery Performed
Twelve patients (24%) were found to have simple (one-segment) MVP, including three patients with FED and nine patients showing only mild myxomatous changes. Thirty-eight
Discussion
In this study of patients with mainly advanced MVP undergoing MV repair, the overall accuracy in detecting prolapse (correct detection of all prolapsed segments) was higher for 3D TEE than for 2D TEE. Compared with direct surgical measurements, 3D TEE was more accurate than 2D TEE in quantifying MV anatomy. Patients with more advanced MVP, as assessed by our integrative 3D transesophageal echocardiographic approach, required a more complex type of MV repair.
Conclusions
In a population of patients with mainly advanced degenerative MV disease, MV quantification on 3D TEE was comparable with direct surgical measurements, and the accuracy for detecting MVP was higher on 3D TEE compared with 2D TEE. Quantitative MV characteristics as assessed by 3D TEE determined the complexity of MV repair.
References (42)
- et al.
A comparison of outcomes of mitral valve repair for degenerative disease with posterior, anterior, and bileaflet prolapse
J Thorac Cardiovasc Surg
(2005) Outcomes of mitral valve repair for mitral regurgitation due to degenerative disease
Semin Thorac Cardiovasc Surg
(2007)- et al.
Identifying patients with degenerative mitral regurgitation for mitral valve repair and replacement: a transesophageal echocardiographic study
J Am Soc Echocardiogr
(2004) - et al.
Intraoperative transesophageal echocardiography accurately predicts mitral valve anatomy and suitability for repair
J Am Soc Echocardiogr
(2002) - et al.
Systolic anterior motion after mitral valve repair: an exceptional cause of late failure
J Thorac Cardiovasc Surg
(2005) - et al.
State of the art: degenerative mitral valve disease
Heart Lung Circ
(2009) - et al.
Real-time three-dimensional transesophageal echocardiography in the intraoperative assessment of mitral valve disease
J Am Soc Echocardiogr
(2009) - et al.
Real-time three-dimensional transesophageal echocardiography for assessment of mitral valve functional anatomy in patients with prolapse-related regurgitation
Am J Cardiol
(2011) - et al.
Real-time three-dimensional transesophageal echocardiography in valve disease: comparison with surgical findings and evaluation of prosthetic valves
J Am Soc Echocardiogr
(2008) - et al.
Comparative accuracy of two- and three-dimensional transthoracic and transesophageal echocardiography in identifying mitral valve pathology in patients undergoing mitral valve repair: initial observations
J Am Soc Echocardiogr
(2011)
Valvular heart disease. The value of 3-dimensional echocardiography
J Am Coll Cardiol
Is the anterior intertrigonal distance increased in patients with mitral regurgitation due to leaflet prolapse?
Ann Thorac Surg
A framework for systematic characterization of the mitral valve by real-time three-dimensional transesophageal echocardiography
J Am Soc Echocardiogr
Long-term survival in asymptomatic patients with severe degenerative mitral regurgitation: a propensity score-based comparison between an early surgical strategy and a conservative treatment approach
J Thorac Cardiovasc Surg
Assessment of mitral valve prolapse by 3D TEE: angled views are key
JACC Cardiovasc Imaging
Etiologic classification of degenerative mitral valve disease: Barlow’s disease and fibroelastic deficiency
Semin Thorac Cardiovasc Surg
Mitral annulus dynamics early after valve repair: preliminary observations of the effect of resectional versus non-resectional approaches
J Am Soc Echocardiogr
Utility of combined two-dimensional and three-dimensional transesophageal imaging for catheter-based mitral valve clip repair of mitral regurgitation
J Am Soc Echocardiogr
Reoperation after mitral valve repair for degenerative disease
Ann Thorac Surg
Quantitative analysis of mitral valve apparatus in mitral valve prolapse before and after annuloplasty: a three-dimensional intraoperative transesophageal study
J Am Soc Echocardiogr
Seeking a higher standard for degenerative mitral valve repair: begin with etiology
J Thorac Cardiovasc Surg
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Drs. Biaggi and Jedrzkiewicz contributed equally to this work.