Clinical Utility of Three-Dimensional Echocardiography in the Evaluation of Mitral Valve Disease: Tips and Tricks

Pino, Paolo Giuseppe; Madeo, Andrea; Lucà, Fabiana; Ceravolo, Roberto; Fusco, Stefania Angela Di; Benedetto, Francesco; Bisignani, Giovanni; Oliva, Fabrizio; Colivicchi, Furio; Gulizia, Michele Massimo; Gelsomino, Sandro

doi:10.3390/jcm12072522

Cited by 6 publications

(4 citation statements)

References 86 publications

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“…Global assessment of the RV is recommended; thus, we chose RVFAC as the echocardiographic parameter in this study. Three-dimensional (3D) echocardiography may improve the situation; however, especially in intraoperative TEE, measuring 3D RVEF in real time remains difficult owing to some technological issues, and does not seem to be practical at least in the current clinical settings ( 9 , 30 , 31 ). Since QRS RV could simply indicate the electrophysiological activity of the RV, it might have bypassed the above limitations of echocardiography and might have revealed perioperatively reduced RV function after CPB, which RVFAC did not capture.…”

Section: Discussionmentioning

confidence: 99%

Possible role of QRS duration in the right ventricle as a perioperative monitoring parameter for right ventricular function: a prospective cohort analysis in robotic mitral valve surgery

Watanabe,

Hori,

Ishihara

et al. 2024

Front. Cardiovasc. Med.

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BackgroundThe clinical importance of the right ventricle (RV) has recently been recognized; however, assessing its function during cardiac surgery remains challenging owing to its complex anatomy. A temporary transvenous pacing catheter is a useful tool in the small surgical field of minimally invasive cardiac surgery, and an electrocardiogram recorded through the catheter is composed of the direct electrophysiological activity of the RV. Therefore, we hypothesized that QRS duration in the RV (QRSRV) could be a useful monitoring parameter for perioperative RV function.MethodsWe conducted a prospective cohort analysis involving adult patients undergoing robotic mitral valve repair. A bipolar pacing catheter was inserted using x-ray fluoroscopy, and the QRSRV duration was assessed at four time points: preoperative baseline, during one-lung ventilation, after weaning from cardiopulmonary bypass, and before the end of surgery. At the same time points, right ventricular fractional area change (RVFAC) measured by transesophageal echocardiography and QRS duration at V5 lead of the body surface electrocardiogram (QRSV5) were also evaluated.ResultsIn the 94 patients analyzed, QRSRV duration was significantly prolonged during robotic mitral valve repair (p = 0.0009), whereas no significant intraoperative changes in RVFAC were observed (p = 0.2). By contrast, QRSV5 duration was significantly shortened during surgery (p < 0.00001). Multilinear regression showed a significant correlation of QRSRV duration with RVFAC (p = 0.00006), but not with central venous pressure (p = 0.9), or left ventricular ejection fraction (p = 0.3). When patients were divided into two groups by postoperative QRSRV > 100 or ≤100 ms, 25 patients (26.6%) exhibited the prolonged QRSRV duration, and the mean increase in the postoperative QRSRV from preoperative baseline was 12 ms (p = 0.001), which was only 0.6 ms in patients with QRSRV ≤ 100 ms (p = 0.6). Cox regression analysis showed that prolonged postoperative QRSRV duration was the only significant parameter associated with a longer ICU stay after surgery (p = 0.02; hazard ratio, 0.55).ConclusionOur data suggest that QRSRV duration is a useful parameter for monitoring the RV during cardiac surgery, possibly better than a commonly used echocardiographic parameter, RVFAC. An electrophysiological assessment by QRSRV duration could be a practical tool for the complex anatomy of the RV, especially with limited modalities in perioperative settings.

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Section: Discussionmentioning

confidence: 99%

Possible role of QRS duration in the right ventricle as a perioperative monitoring parameter for right ventricular function: a prospective cohort analysis in robotic mitral valve surgery

Watanabe,

Hori,

Ishihara

et al. 2024

Front. Cardiovasc. Med.

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“…Todo ecocardiografista que inicia no mundo 3D busca literatura e diretrizes sobre ajustes ideais de ganho, suavização (smoothing) e compressão para otimizar imagens 3D, mas esses dados são escassos. 6 Via de regra, devemos lembrar que quando reduzimos a compressão, estamos na realidade produzindo imagens mais contrastadas, que facilitam a avaliação de estruturas finas ou delicadas.…”

Section: Pós-processamento Dos Volumes Obtidosunclassified

Como Eu Faço Ecocardiograma Tridimensional na Insuficiência Mitral: Como e Quando

Cañellas

2024

Arq Bras Cardiol: Imagem cardiovasc.

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O Ecocardiograma Tridimensional (3D) é uma ferramenta indispensável em todas as etapas da valvulopatia mitral, desde o seu diagnóstico até o momento do tratamento, tendo papel fundamental principalmente na decisão por plastia cirúrgica ou correção percutânea. Neste artigo, procuramos apresentar conceitos básicos muito importantes no uso da técnica, desde a obtenção da imagem bidimensional (2D), passando pelas principais ferramentas de obtenção de imagens 3D, até as novas soluções trazidas pelos fabricantes para apresentação das imagens e softwares de pós-processamento. Esse conhecimento é fundamental e contribui para a desmistificação do Eco 3D, muitas vezes rotulado como de difícil execução e ainda pouco incorporado em nossa prática clínica.

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“…Every echocardiographer debuting in the 3D world searches for literature and guidelines on ideal gain adjustments, smoothing, and compression to optimize 3D images, but this data is scarce. 6 As a rule, we must remember that when compression is reduced, one is actually producing more contrasted images, which facilitate the evaluation of fine or delicate structures.…”

Section: Post Processing Of Obtained Volumesmentioning

confidence: 99%

My Approach to 3D Echocardiography in Mitral Valve Insufficiency: How and When

Cañellas

2024

ABC Imagem Cardiovascular

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3D Echocardiogram is an indispensable tool in all stages of mitral valve disease, from its diagnosis to the moment of treatment, playing a fundamental role mainly in the decision for surgical plasty or percutaneous correction. In this article, we sought to present very important basic concepts in the use of the technique, from obtaining a 2D image, through the main tools for obtaining 3D images, to new solutions Correspondência: Fábio Cañellas •

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Clinical Utility of Three-Dimensional Echocardiography in the Evaluation of Mitral Valve Disease: Tips and Tricks

Cited by 6 publications

References 86 publications

Possible role of QRS duration in the right ventricle as a perioperative monitoring parameter for right ventricular function: a prospective cohort analysis in robotic mitral valve surgery

Possible role of QRS duration in the right ventricle as a perioperative monitoring parameter for right ventricular function: a prospective cohort analysis in robotic mitral valve surgery

Como Eu Faço Ecocardiograma Tridimensional na Insuficiência Mitral: Como e Quando

My Approach to 3D Echocardiography in Mitral Valve Insufficiency: How and When

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