Comparative Accuracy of Two- and Three-Dimensional Transthoracic and Transesophageal Echocardiography in Identifying Mitral Valve Pathology in Patients Undergoing Mitral Valve Repair: Initial Observations

Zekry, Sagit Ben; Nagueh, Sherif F.; Little, Stephen H.; Quiñones, Miguel Á.; McCulloch, Marti; Singh, Karanbir; Herrera, Elizabeth; Lawrie, Gerald M.; Zoghbi, William A.

doi:10.1016/j.echo.2011.06.011

Cited by 94 publications

(51 citation statements)

References 16 publications

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“…[1][2][3][5][6][7][8][9] Importantly, the identification of commissural lesions has greatly improved with 3D TEE with published sensitivity, specificity and accuracy ranging from 89% to 92%, 95% to 99% and 93% to 97%, respectively. This is higher than the sensitivity (54%-66%), specificity (90% to 95%) and accuracy (82% to 89%) reported with 2D TEE.…”

Section: D Echocardiography Improves Lesion Localization and Quantifmentioning

confidence: 99%

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Three-dimensional Echocardiography Is Essential for Intraoperative Assessment of Mitral Regurgitation

Tsang

Lang²

2013

Circulation

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Since its introduction, 3-dimensional (3D) transesophageal echocardiography (TEE) has become widely adopted in operating rooms and cardiac catheterization laboratories worldwide. This is because the matrix-array 3D TEE probe allows acquisition of high-quality 3D images in real time with relatively little training. The rapid adoption of this technology has proven that this innovative imaging modality provides additional clinical information beyond that obtained from 2-dimensional (2D) TEE images. These developments have enabled medical centers to create integrated valve programs in which surgeons, interventionalists, and echocardiographers discuss cases and surgical approaches. Response by McCarthy on p 652In particular, 3D TEE has been proven to be superior to 2D TEE in the assessment of both mitral valve anatomy and mitral regurgitation, promoting its use in the operating room (Table 1). [1][2][3] One reason for this superiority is that 3D TEE allows the mitral valve to be displayed en face in an orientation identical to the surgeon's view of the mitral valve intraoperatively. This surgeon's view greatly facilitates communication with cardiac surgeons because they can easily interpret these images.Here, we argue that the widespread acceptance and use of 3D TEE are attributable to the pivotal role this modality plays in the intraoperative assessment of mitral regurgitation. We believe that 3D TEE of the mitral valve is invaluable not only because of the realistic images it provides but also because it improves: 1) lesion localization, 2) identification of the mechanisms causing mitral regurgitation, 3) quantification of the severity of mitral regurgitation, 4) selection of surgical intervention, 5) the choice of the surgeon whose expertise is best suited to perform the operation, 6) guidance of percutaneous mitral valve procedures, and 7) postoperative assessment. 3D Echocardiography of the Mitral ValveAccurate preoperative assessment of the mitral valve is critical in the surgical management of patients with severe mitral regurgitation. This information determines whether the patient should undergo valve repair or replacement, which has implications in terms of timing of surgery and long-term morbidity and mortality. 4 Traditionally, 2D TEE has been used to evaluate mitral valve anatomy. However, 2D TEE requires manual manipulation of the transducer in the esophagus and various degrees of flexion or anteflexion of the probe to acquire the standard mid-esophageal views and to examine all leaflet scallops. Since 2D TEE only provides single plane images, the entire mitral annulus and leaflets are not displayed in a single en face view, making it difficult to identify specific scallops with precision. As well, because the mitral annulus is saddle shaped, distortions of mitral valve anatomy, mitral annular dilatation, or aortic root enlargement may change the orientation of the ultrasound plane in relation to mitral valve apparatus, resulting in scallop misidentification.

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Section: D Echocardiography Improves Lesion Localization and Quantifmentioning

confidence: 99%

“…[1][2][3] One reason for this superiority is that 3D TEE allows the mitral valve to be displayed en face in an orientation identical to the surgeon's view of the mitral valve intraoperatively. This surgeon's view greatly facilitates communication with cardiac surgeons because they can easily interpret these images.…”

Section: Response By Mccarthy On P 652mentioning

confidence: 99%

Three-dimensional Echocardiography Is Essential for Intraoperative Assessment of Mitral Regurgitation

Tsang

Lang²

2013

Circulation

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“…Particularly, three-dimensional (3D) echocardiography provides detailed information, including clear visualization and quantitative assessment of mitral apparatus [3][4][5][6]. Recent data showed that findings from 3D echocardiography are well correlated with operative findings during mitral valve repair in comparison to two-dimensional (2D) echocardiography [7][8][9]. However, few data exist regarding the clinical role of 3D-TEE in mitral valve repair.…”

Section: Introductionmentioning

confidence: 99%

Impact of real-time three-dimensional transesophageal echocardiography on procedural success for mitral valve repair

et al. 2015

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Background For mitral valve repair, minimally invasive cardiac surgery as well as transcatheter valvular intervention have been developed. Under these conditions, threedimensional transesophageal echocardiography (3D-TEE) plays a key role for planning the surgical treatment strategy. However, few data exist regarding the role of 3D-TEE in mitral valve repair. Therefore, we examined the impact of 3D-TEE on procedural success of mitral valve repair. Methods and resultsWe examined 86 consecutive patients who underwent mitral valve repair for degenerative mitral valve prolapse. Among them, 39 patients were examined by only two-dimensional transesophageal echocardiography (2D-TEE) and 47 patients underwent 3D-TEE in addition to 2D-TEE. The cardiac surgeons and physicians discussed the repair procedure preoperatively with the echocardiographic images. As a result, 18 patients of the 2D-TEE group and 37 patients of the 3D-TEE group underwent mitral valve repair by small thoracotomy including robotic approach. Simple repair was done in 21 with 2D-TEE and 21 with 3D-TEE and complex repair was done in 18 with 2D-TEE and 26 with 3D-TEE.Importantly, three patients with 2D-TEE before surgery had to undergo reoperation due to recurrent severe mitral regurgitation with dehiscence of the annuloplasty rings, although none with 3D-TEE did. Conclusions These results demonstrate that 3D-TEE is helpful in assessing the morphology of mitral apparatus and complexity of mitral valve repair, particularly in minimally invasive cardiac surgery including robotic ones. We would suggest that sonographers, cardiologists, and cardiac surgeons should be familiar with 3D-TEE and work together throughout the perioperative period for better outcomes.

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“…However, the results of this study in comparing different expertise would still be valid. 3D-TTe images were not included in the present study because it is well agreed that even in the hand of experts 3D-TTE has limited accuracy in prolapse identification [3,[13][14][15]. Finally, each reader group consisted of only a small number of readers.…”

Section: Limitationsmentioning

confidence: 99%

“…it is well recognized that a high level of expertise is required for accurate acquisition and interpretation of the 2D images. More recently, in several studies it has been demonstrated that 3D-TOe may be more easy and accurate to identify the locations of MV prolapse [3][4][5][6]. However, the generalizability of 3D-TOe publications has been questioned since the observers were usually highly experienced experts working in academic referral centers.…”

Section: Introductionmentioning

confidence: 99%

The role of experience in echocardiographic identification of location and extent of mitral valve prolapse with 2D and 3D echocardiography

Laat

Ren

McGhie

et al. 2016

Int J Cardiovasc Imaging

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also improved the agreement (+12 to +16 %) and Kappa values (+0.14 to +0.21) in all reader groups for the exact description of P2 prolapse. Differences between readers with variable experience in determining the precise localization and extent of the prolapsing posterior MV scallops exist in particular in 2D-TTe analysis. 3D-TOe analysis was extremely fast compared to the 2D analysis methods and showed the best diagnostic accuracy (mainly driven by specificity) with identification of P1 and P3 prolapse still improving from novice to trainees to cardiologists and provided optimal description of P2 prolapse extent.

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Comparative Accuracy of Two- and Three-Dimensional Transthoracic and Transesophageal Echocardiography in Identifying Mitral Valve Pathology in Patients Undergoing Mitral Valve Repair: Initial Observations

Cited by 94 publications

References 16 publications

Three-dimensional Echocardiography Is Essential for Intraoperative Assessment of Mitral Regurgitation

Three-dimensional Echocardiography Is Essential for Intraoperative Assessment of Mitral Regurgitation

Impact of real-time three-dimensional transesophageal echocardiography on procedural success for mitral valve repair

The role of experience in echocardiographic identification of location and extent of mitral valve prolapse with 2D and 3D echocardiography

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