Live/Real Time Three‐Dimensional Transesophageal Echocardiographic Evaluation of Mitral and Aortic Valve Prosthetic Paravalvular Regurgitation

Abstract

Thirteen patients already scheduled for surgery for repair of prosthetic paravalvular regurgitation underwent intraoperative real time two-dimensional transesophageal echocardiography (2D TEE) and live/real time three-dimensional transesophageal echocardiography (3D TEE). In all patients, 3D TEE was able to provide more information regarding the location and size of the paravalvular defect as compared to 2D TEE. 3D TEE resulted in a more accurate localization of the defect and an estimation of the size of the defect that correlated much more closely with surgical findings when compared with 2D TEE. Our preliminary results demonstrate the superiority of 3D TEE over 2D TEE in the evaluation of paravalvular prosthetic regurgitation. 3D TEE not only provides an accurate assessment of the exact site of the leakage, but also gives a more accurate estimate of its size. This information could be valuable to surgeons who may encounter difficulty when localizing and estimating the size of paraprosthetic leaks while the heart is devoid of blood during surgery.

Evaluation of Transmitral Pressure Gradients in the Intraoperative Echocardiographic Diagnosis of Mitral Stenosis after Mitral Valve Repair

“…Finally, 3D echocardiography is a rapidly evolving technique which is increasingly used intraoperatively during mitral valvuloplasty [41] and mitral valve repair [42]. In primary, native mitral stenosis, estimation of MVA with 3D echocardiography is considered to be the gold standard of diagnosis of mitral stenosis by some authors [43].…”

Intraoperative Evaluation of Transmitral Pressure Gradients after Edge-to-Edge Mitral Valve Repair

“…However, the intraoperative 2D visualization from a transgastric short axis view might be challenging especially after edge-to-edge repair, due to the inability to confirm exact parallel alignment to the orifice. Intraoperative 3D echocardiography is becoming increasingly more prevalent [29], [30]. The improved imaging displays and infinite cropping capabilities enabled with large volume 3D TEE data sets may overcome these shortcomings [31].…”

The role of echocardiography in the evaluation and management of aortic stenosis in the older adult

“…Whether 3DTTE or 3DTEE will ultimately be used in guiding percutaneous AVR is not clear, both are more suited than 2D echocardiography for interrogating the prosthetic valve in the immediate post-deployment period for the assessment of paravalvular aortic regurgitation and deciding whether further balloon dilatations should be performed before the patient leaves the intervention suite (Fig. 8) [77,78].…”