Transthoracic echocardiography in patients undergoing mitral valve repair: comparison of new transthoracic 3D techniques to 2D transoesophageal echocardiography in the localization of mitral valve prolapse
- 113 Downloads
Successful mitral valve (MV) repair for degenerative mitral regurgitation (DMR) is mainly related to surgical expertise and MV anatomy. Although 2D echocardiography, specifically transoesophageal (TOE), provides precise information regarding MV anatomy, recent advancements in matrix technology meant a decisive step forward to the point where segmental MV analysis can be accurately performed from a noninvasive 3D transthoracic (TTE) approach. The aims of this study were: (a) to evaluate the feasibility and time required for real-time 3D TTE in a large consecutive cohort of patients with severe DMR in the assessment of MV anatomy; (b) to compare the accuracy of 3D TTE and 2D TOE versus surgical inspection in the recognition and localization of all components of the MV leaflets; (c) to establish the added diagnostic value of 3D colourDoppler examination to pure 3D morphologic evaluation. 149 consecutive patients with severe DMR underwent complete 3D TTE before surgery and 2D TOE in the operating room. Echocardiographic data obtained by the different techniques were compared with surgical inspection. 3D TTE was feasible in a relatively short time (8 ± 4 min), with good (49%) and optimal (33%) imaging quality in the majority of cases. 3D TTE had significant better overall accuracy compared to 2D TOE (93 and 91%, p < 0.05, respectively). 2D TOE was significantly more specific than 3D TTE in the identification of A3 prolapse (99 vs. 96%). The colourDoppler mode did not improve significantly the accuracy of 3D TTE, albeit it determined a better sensitivity in the detection of A2 prolapse if compared to 2D TOE (95 vs. 85%). 3D TTE with or without colourDoppler is a feasible and useful method in the analysis of MV prolapse; it allows a preoperative and noninvasive description of the pathology as accurate as the 2D TOE.
KeywordsMitral valve prolapse 3D echocardiography Surgical inspection
Compliance with ethical standards
Conflict of interest
Authors declare no conflict of interest.
All procedures performed in the study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
Research with human and animal participants
This article does not contain any studies with animals performed by any of the authors.
- 2.Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC), European Association for Cardio-Thoracic Surgery (EACTS), Vahanian A, Alfieri O, Andreotti F et al (2012) Guidelines on the management of valvular heart disease (version 2012). Eur Heart J 33(19):2451–2496. https://doi.org/10.1093/eurheartj/ehs109 CrossRefGoogle Scholar
- 6.Montant P, Chenot F, Robert A, Vancraeynest D, Pasquet A, Gerber B, Noirhomme P, El Khoury G, Vanoverschelde JL (2009) 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 138(6):1339–1348. https://doi.org/10.1016/j.jtcvs.2009.03.046 CrossRefPubMedGoogle Scholar
- 8.Gammie JS, O’Brien SM, Griffith BP, Ferguson TB, Peterson ED (2007) Influence of hospital procedural volume on care process and mortality for patients undergoing elective surgery for mitral regurgitation. Circulation 115(7):881–887. https://doi.org/10.1161/CIRCULATIONAHA.106.634436 CrossRefPubMedGoogle Scholar
- 14.Gammie JS, Sheng S, Griffith BP, Peterson ED, Rankin JS, O’Brien S, Brown JM (2009) Trends in mitral valve surgery in the United States: results from the Society of Thoracic Surgeons Adult Cardiac Surgery Database. Ann Thorac Surg 87(5):1431–1439. https://doi.org/10.1016/j.athoracsur.2009.01.064 CrossRefPubMedGoogle Scholar
- 18.Pepi M, Tamborini G, Maltagliati A, Galli CA, Sisillo E, Salvi L, Naliato M, Porqueddu M, Parolari A, Zanobini M, Alamanni F (2006) Head-to-head comparison of two- and three-dimensional transthoracic and transesophageal echocardiography in the localization of mitral valve prolapse. J Am Coll Cardiol 48(2):2524–2530. https://doi.org/10.1016/j.jacc.2006.02.079 CrossRefPubMedGoogle Scholar
- 19.Patel V, Hsiung MC, Nanda NC et al (2006) Usefulness of live/real time three-dimensional transthoracic echocardiography in the identification of individual segment/scallop prolapse of the mitral valve. Echocardiography 23(6):513–518. https://doi.org/10.1111/j.1540-8175.2006.00252.x CrossRefPubMedGoogle Scholar
- 20.Muller S, Muller L, Laufer G, Alber H, Dichtl W, Frick M, Pachinger O, Bartel T (2006) Comparison of three-dimensional imaging to transesophageal echocardiography for preoperative evaluation in mitral valve prolapse. Am J Cardiol 98(2):243–248. https://doi.org/10.1016/j.amjcard.2006.01.076 CrossRefPubMedGoogle Scholar
- 21.Sharma R, Mann J, Drummond L, Livesey SA, Simpson IA (2007) The evaluation of real-time 3-dimensional transthoracic echocardiography for the preoperative functional assessment of patients with mitral valve prolapse: a comparison with 2-dimensional transesophageal echocardiography. J Am Soc Echocardiogr 20(8):934–940. https://doi.org/10.1016/j.echo.2007.01.028 CrossRefPubMedGoogle Scholar
- 22.Manda J, Kesanolla SK, Hsuing MC, Nanda NC, Abo-Salem E, Dutta R, Laney CA, Wei J, Chang CY, Tsai SK, Hansalia S, Yin WH, Young MS (2008) Comparison of real time two-dimensional with live/real time three-dimensional transesophageal echocardiography in the evaluation of mitral valve prolapse and chordae rupture. Echocardiography 25(10):1131–1137. https://doi.org/10.1111/j.1540-8175.2008.00832.x CrossRefPubMedGoogle Scholar
- 23.Gutierrez-Chico JL, Zamorano Gomez JL, Rodrigo-Lopez JL, Mataix L, Perez de Isla L, Ameria-Valera C, Aubele A, Macaya-Miguel C (2008) Accuracy of real-time 3-dimensional echocardiography in the assessment of mitral prolapse: is transesophageal echocardiography still mandatory? Am Heart J 155(4):694–698. https://doi.org/10.1016/j.ahj.2007.10.045 CrossRefPubMedGoogle Scholar
- 24.Tamborini G, Muratori M, Maltagliati A, Galli CA, Naliato M, Zanobini M, Alamanni F, Salvi L, Sisillo E, Fiorentini C, Pepi M (2010) Pre-operative transthoracic real-time three-dimensional echocardiography in patients undergoing mitral valve repair: accuracy in cases with simple vs. complex prolapse lesions. Eur J Echocardiogr 11(9):778–785. https://doi.org/10.1093/ejechocard/jeq066 CrossRefPubMedGoogle Scholar
- 29.Lancellotti P, Tribouilloy C, Hagendorff A, Popescu BA, Edvardsen T, Pierard LA, Badano L, Zamorano JL, Scientific Document Committee of the European Association of Cardiovascular Imaging (2013) Recommendations for the echocardiographic assessment of native valvular regurgitation: an executive summary from the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 14(7):611–644. https://doi.org/10.1093/ehjci/jet105 CrossRefPubMedGoogle Scholar
- 30.Biaggi P, Jedrzkiewicz S, Gruner C, Meineri M, Karski J, Vegas A, Tanner FC, Rakowski H, Ivanov J, David TE, Woo A (2012) Quantification of mitral valve anatomy by three-dimensional transesophageal echocardiography in mitral valve prolapse predicts surgical anatomy and the complexity of mitral valve repair. J Am Soc Echocardiogr 25(7):758–765. https://doi.org/10.1016/j.echo.2012.03.010 CrossRefPubMedGoogle Scholar
- 31.La Canna G, Arendar I, Maisano F, Monaco F, Collu E, Benussi S, De Bonis M, Castiglioni A, Alfieri O (2011) Real-time three-dimensional transesophageal echocardiography for assessment of mitral valve functional anatomy in patients with prolapse-related regurgitation. Am J Cardiol 107(9):1365–1374. https://doi.org/10.1016/j.amjcard.2010.12.048 CrossRefPubMedGoogle Scholar