Skip to main content
SpringerLink
Log in

The Mitral Valve by Three-Dimensional Echocardiography

  • Published:
Current Cardiovascular Imaging Reports Aims and scope Submit manuscript

Abstract

A comprehensive evaluation of patients with mitral valve disease must include an echocardiographic examination of the mitral valve apparatus and resultant hemodynamic changes due to mitral pathology. Three-dimensional echocardiography has impacted on the diagnosis of mitral valve prolapse but has mostly existed in a research realm. After decades of development, three-dimensional echocardiography is now easily performed and readily incorporated in the assessment of mitral valve disease in daily clinical practice. Unique anatomic views of the mitral valve, accurate quantitative assessment of the mitral valve orifice area, and delineation of segmental prolapse are several advantages of three-dimensional echocardiography. Moreover, there is a wealth of data that can be derived from a three-dimensional volume, enabling more detailed analysis of mitral valve apparatus and valve annular dynamics. This review highlights current applications of three-dimensional echocardiography in the routine evaluation of mitral valve disease.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. •• Levine RA, Handschumacher MD, Sanfilippo AJ, et al.: Three-dimensional echocardiographic reconstruction of the mitral valve, with implications for the diagnosis of mitral valve prolapse. Circulation 1989, 80:589–598. This study demonstrated the non-planarity of the MV annulus and defined the way that we diagnose MV prolapse.

    CAS  PubMed  Google Scholar 

  2. Zamorano J, Cordeiro P, Sugeng L, et al.: Real-time three-dimensional echocardiography for rheumatic mitral valve stenosis evaluation: an accurate and novel approach. J Am Coll Cardiol 2004, 43:2091–2096.

    Article  PubMed  Google Scholar 

  3. Binder TM, Rosenhek R, Porenta G, et al.: Improved assessment of mitral valve stenosis by volumetric real-time three-dimensional echocardiography. J Am Coll Cardiol 2000, 36:1355–1361.

    Article  CAS  PubMed  Google Scholar 

  4. Sugeng L, Weinert L, Lammertin G, et al.: Accuracy of mitral valve area measurements using transthoracic rapid freehand 3-dimensional scanning: comparison with noninvasive and invasive methods. J Am Soc Echocardiogr 2003, 16:1292–1300.

    Article  PubMed  Google Scholar 

  5. Gorman JH III, Jackson BM, Enomoto Y, Gorman RC: The effect of regional ischemia on mitral valve annular saddle shape. Ann Thorac Surg 2004, 77:544–548

    Article  PubMed  Google Scholar 

  6. •• Otsuji Y, Handschumacher MD, Liel-Cohen N, et al.: Mechanism of ischemic mitral regurgitation with segmental left ventricular dysfunction: three-dimensional echocardiographic studies in models of acute and chronic progressive regurgitation. J Am Coll Cardiol 2001, 37:641–648. This study used 3DE to give insight into the mechanism of ischemic MR.

    Article  CAS  PubMed  Google Scholar 

  7. • Carpentier A: Cardiac valve surgery—the “French correction”. J Thorac Cardiovasc Surg 1983, 86:323–337. This article discusses the pathophysiology triad of MR and the type of MV pathology.

    CAS  PubMed  Google Scholar 

  8. O’Gara P, Sugeng L, Lang R, et al.: The role of imaging in chronic degenerative mitral regurgitation. JACC Cardiovasc Imaging 2008, 1:221–237.

    Article  PubMed  Google Scholar 

  9. Grewal KS, Malkowski MJ, Kramer CM, et al.: Multiplane transesophageal echocardiographic identification of the involved scallop in patients with flail mitral valve leaflet: intraoperative correlation. J Am Soc Echocardiogr 1998, 11:966–971.

    Article  CAS  PubMed  Google Scholar 

  10. Zamorano J, Erbel R, Mackowski T, et al.: Usefulness of transesophageal echocardiography for diagnosis of mitral valve prolapse. Am J Cardiol 1992, 69:419–422.

    Article  CAS  PubMed  Google Scholar 

  11. Shanewise JS, Cheung AT, Aronson S, et al.: ASE/SCA guidelines for performing a comprehensive intraoperative multiplane transesophageal echocardiography examination: recommendations of the American Society of Echocardiography Council for Intraoperative Echocardiography and the Society of Cardiovascular Anesthesiologists Task Force for Certification in Perioperative Transesophageal Echocardiography. J Am Soc Echocardiogr 1999, 12:884–900.

    Article  CAS  PubMed  Google Scholar 

  12. Stewart WJ, Griffin B, Thomas JD: Multiplane transesophageal echocardiographic evaluation of mitral valve disease. Am J Card Imaging 1995, 9:121–128.

    CAS  PubMed  Google Scholar 

  13. Muller S, Muller L, Laufer G, et al.: Comparison of three-dimensional imaging to transesophageal echocardiography for preoperative evaluation in mitral valve prolapse. Am J Cardiol 2006, 98:243–248.

    Article  PubMed  Google Scholar 

  14. Pepi M, Tamborini G, Maltagliati A, et al.: Head-to-head comparison of two-and three-dimensional transthoracic and transesophageal echocardiography in the localization of mitral valve prolapse. J Am Coll Cardiol 2006, 48:2524–2530.

    Article  PubMed  Google Scholar 

  15. Salustri A, Becker AE, van Herwerden L, et al.: Three-dimensional echocardiography of normal and pathologic mitral valve: a comparison with two-dimensional transesophageal echocardiography. J Am Coll Cardiol 1996, 27:1502–1510.

    Article  CAS  PubMed  Google Scholar 

  16. Zamorano J, Perez DI, Sugeng L, et al.: Non-invasive assessment of mitral valve area during percutaneous balloon mitral valvuloplasty: role of real-time 3D echocardiography. Eur Heart J 2004, 25:2086–2091.

    Article  PubMed  Google Scholar 

  17. Messika-Zeitoun D, Brochet E, Holmin C, et al.: Three-dimensional evaluation of the mitral valve area and commissural opening before and after percutaneous mitral commissurotomy in patients with mitral stenosis. Eur Heart J 2007, 28:72–79.

    Article  PubMed  Google Scholar 

  18. Messas E, Guerrero JL, Handschumacher MD, et al.: Paradoxic decrease in ischemic mitral regurgitation with papillary muscle dysfunction: insights from three-dimensional and contrast echocardiography with strain rate measurement. Circulation 2001, 104:1952–1957.

    Article  CAS  PubMed  Google Scholar 

  19. Ryan LP, Jackson BM, Parish LM, et al.: Regional and global patterns of annular remodeling in ischemic mitral regurgitation. Ann Thorac Surg 2007, 84:553–559.

    Article  PubMed  Google Scholar 

  20. Song JM, Qin JX, Kongsaerepong V, et al.: Determinants of ischemic mitral regurgitation in patients with chronic anterior wall myocardial infarction: a real time three-dimensional echocardiography study. Echocardiography 2006, 23:650–657.

    Article  PubMed  Google Scholar 

  21. Veronesi F, Corsi C, Sugeng L, et al.: Quantification of mitral apparatus dynamics in functional and ischemic mitral regurgitation using real-time 3-dimensional echocardiography. J Am Soc Echocardiogr 2008, 21:347–354.

    Article  PubMed  Google Scholar 

  22. Watanabe N, Ogasawara Y, Yamaura Y, et al.: Geometric deformity of the mitral annulus in patients with ischemic mitral regurgitation: a real-time three-dimensional echocardiographic study. J Heart Valve Dis 2005, 14:447–452.

    PubMed  Google Scholar 

  23. Watanabe N, Ogasawara Y, Yamaura Y, et al.: Geometric differences of the mitral valve tenting between anterior and inferior myocardial infarction with significant ischemic mitral regurgitation: quantitation by novel software system with transthoracic real-time three-dimensional echocardiography. J Am Soc Echocardiogr 2006, 19:71–75.

    Article  PubMed  Google Scholar 

  24. Hung J, Guerrero JL, Handschumacher MD, et al.: Reverse ventricular remodeling reduces ischemic mitral regurgitation: echo-guided device application in the beating heart. Circulation 2002, 106:2594–2600.

    Article  PubMed  Google Scholar 

  25. Messas E, Pouzet B, Touchot B, et al.: Efficacy of chordal cutting to relieve chronic persistent ischemic mitral regurgitation. Circulation 2003, 108(Suppl 1):II111–II115.

    Google Scholar 

  26. •• Agricola E, Oppizzi M, Pisani M, et al.: Ischemic mitral regurgitation: mechanisms and echocardiographic classification. Eur J Echocardiogr 2008, 9:207–221. This is an excellent review on ischemic MR.

    PubMed  Google Scholar 

  27. Bonow RO, Carabello BA, Chatterjee K, et al.: 2008 focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to revise the 1998 guidelines for the management of patients with valvular heart disease). Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol 2008, 52:e1–142.

    Article  PubMed  Google Scholar 

Download references

Disclosure

Dr. Sugeng serves on the speakers’ bureau for Philips Medical Imaging Systems and has received a software grant from TomTec Imaging Systems.

Author information

Authors and Affiliations

  1. University of Chicago Medical Center, 5841 South Maryland Avenue, MC5084, Chicago, IL, 60637, USA

    Lissa Sugeng & Lynn Weinert

Authors
  1. Lissa Sugeng
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lynn Weinert
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lissa Sugeng.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Sugeng, L., Weinert, L. The Mitral Valve by Three-Dimensional Echocardiography. Curr Cardiovasc Imaging Rep 3, 252–257 (2010). https://doi.org/10.1007/s12410-010-9042-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12410-010-9042-8

Keywords

Search

Navigation