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

  • Paola GripariEmail author
  • Massimo Mapelli
  • Ilaria Bellacosa
  • Concetta Piazzese
  • Maria Milo
  • Laura Fusini
  • Manuela Muratori
  • Sarah Ghulam Ali
  • Gloria Tamborini
  • Mauro Pepi
Original Paper


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.


Mitral valve prolapse 3D echocardiography Surgical inspection 


Compliance with ethical standards

Conflict of interest

Authors declare no conflict of interest.

Ethical approval

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

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.


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Copyright information

© Springer Science+Business Media B.V., part of Springer Nature 2018

Authors and Affiliations

  • Paola Gripari
    • 1
    Email author
  • Massimo Mapelli
    • 1
  • Ilaria Bellacosa
    • 1
  • Concetta Piazzese
    • 1
  • Maria Milo
    • 1
  • Laura Fusini
    • 1
  • Manuela Muratori
    • 1
  • Sarah Ghulam Ali
    • 1
  • Gloria Tamborini
    • 1
  • Mauro Pepi
    • 1
  1. 1.Department of Cardiovascular Imaging, Centro Cardiologico MonzinoIstituto di Ricovero e Cura a Carattere ScientificoMilanItaly

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