A Novel 3-Dimensional Approach for the Echocardiographic Evaluation of Mitral Valve Area After Repair for Degenerative Disease

Abstract

BACKGROUND: Currently available 2-dimensional (2D) echocardiographic methods for accurately assessing the mitral valve orifice area (MVA) after mitral valve repair (MVr) are limited due to its complex 3-dimensional (3D) geometry. We compared repaired MVAs obtained with commonly used 2D and 3D echocardiographic methods to a 3D orifice area (3DOA), which is a novel echocardiographic measurement and independent of geometric assumptions. METHODS: Intraoperative 2D and 3D transesophageal echocardiography (TEE) images from 20 adult cardiac surgery patients who underwent MVr for mitral regurgitation obtained immediately after repair were retrospectively reviewed. MVAs obtained by pressure half-time (PHT), 2D planimetry (2DP), and 3D planimetry (3DP) were compared to those derived by 3DOA. RESULTS: MVAs (mean value ± standard deviation [SD]) after MVr were obtained by PHT (3 ± 0.6 cm2), 2DP (3.58 ± 0.75 cm2), 3D planimetry (3DP; 2.78 ± 0.74 cm2), and 3DOA (2.32 ± 0.76 cm2). MVAs obtained by the 3DOA method were significantly smaller compared to those obtained by PHT (mean difference, 0.68 cm2; P = .0003), 2DP (mean difference, 1.26 cm2; P < .0001), and 3DP (mean difference, 0.46 cm2; P = .003). In addition, MVA defined as an area ≤1.5 cm2 was identified by 3DOA in 2 patients and by 3DP in 1 patient. CONCLUSIONS: Post-MVr MVAs obtained using the novel 3DOA method were significantly smaller than those obtained by conventional echocardiographic methods and may be consistent with a higher incidence of MVA reduction when compared to 2D techniques. Further studies are still needed to establish the clinical significance of 3D echocardiographic techniques used to measure MVA after MVr.

Novel sizing role of 3D transesophageal echocardiography in a novel left atrial appendage clip device for patients undergoing video-assisted atrial fibrillation ablation: a cohort study

“…3D-TEE has been widely used for device sizing in LAA interventional procedures; however, the difference in the sizing accuracy of the 3DP and 3DV measurements has not yet been investigated. Previous studies have shown that the novel 3DP technique, which has improved accuracy, still uses a 2D plane acquired from the 3D data set for the structures, while the 3DV measurement enables the comprehensive identification of the complex asymmetric 3D borderline and non-planarity of the structures ( 28 , 29 ). In addition, the 3DV measurement measures the anatomic structure independently to patient hemodynamic variability ( 29 ).…”

“…Previous studies have shown that the novel 3DP technique, which has improved accuracy, still uses a 2D plane acquired from the 3D data set for the structures, while the 3DV measurement enables the comprehensive identification of the complex asymmetric 3D borderline and non-planarity of the structures ( 28 , 29 ). In addition, the 3DV measurement measures the anatomic structure independently to patient hemodynamic variability ( 29 ). In this study, we found that the 3DV measurement was more accurate in sizing the LAA clip device than the 3DP measurement.…”

Intraoperative transesophageal echocardiography following mitral valve repair: a systematic review

“… 45 Although a mean gradient of less than 5 mmHg across the valve is characteristic of an adequate repair, 19 Riegel et al pointed out that higher mean gradients up to 7 mmHg immediately post-CPB might be present in situations of increased Left Atrial Pressure (LAP), namely high cardiac output, tachycardia and Atrial Fibrillation (AFib), and this may not cause clinical postoperative MS that needs to be addressed surgicaly. 46 Three observational studies attempted to compare different methods, and none of them showed strong evidence of a superior method 42 , 47 , 48 ( Table 1 ).…”