Three-dimensional echocardiography: Advancements in qualitative and quantitative analyses of mitral valve morphology in mitral valve prolapse

Abstract

Degenerative mitral valve disease (MVD) is the leading cause of organic mitral regurgitation (MR), one of the most common valvular heart disease in western countries. Substantial progresses in the surgical treatment of degenerative MVD have improved life expectancy of patients with significant MR. However, prognosis, surgical decision and timing of surgery strongly depend on the accurate characterization of mitral valve (MV) anatomy and pathology and on the precise quantification of MR. Three-dimensional (3D) echocardiography, a major technological breakthrough in the field of cardiovascular imaging, provides several advantages over two-dimensional (2D) imaging in the qualitative and quantitative evaluations of MV apparatus. In this review, we focus on the contribution of this new modality to the diagnosis of degenerative MVD, the quantitative assessment of MR severity, the selection and monitoring of surgical and percutaneous procedures, the evaluation of procedural outcomes. The results of a systematic and exhaustive search of the existing literature, restricted to real-time 3D echocardiography in adults, are here reported.

TrueVue transillumination volume rendering for three-dimensional transoesophageal echocardiography in interventional imaging

“…Indeed, in this last context, the advantages of transillumination with the light behind the IAS have been previously explored and can really increase the definition of the defects. 11 After reviewing the selected loops from different procedures, two independent observers with different experience in the field of interventional imaging and procedural guidance expressed a moderateto-good agreement regarding the perceived added value of transillumination rendering. Considering the three main categories of concerns, this agreement was the highest for the first group of concerns (the contrast between the structures and the cavity) and lowest for the last group (interaction between heart structures and device).…”

“…Echocardiography is the cornerstone of intraprocedural guidance as it provides real-time images, thus allowing dynamic step-by-step guidance in all the procedures and real-time instantaneous decision-making. [6][7][8][9][10][11] High-resolution, real-time echocardiographic imaging using two-dimensional and three-dimensional modalities and rapid postprocessing imaging inside the operating room are fundamental tools for the treatment of structural heart disease. Three-dimensional echocardiography has been shown to overcome the limits of two-dimensional images in displaying structures and fine details of anatomy.…”

“…The present study represents the first data collection exploring the perceived added value of transillumination rendering compared with the conventional rendering methods in the setting of interventional imaging. Echocardiography is the cornerstone of intraprocedural guidance as it provides real-time images, thus allowing dynamic step-by-step guidance in all the procedures and real-time instantaneous decision-making 6–11 …”

“…This percentage obviously varies across different types of procedure, ranging from 50% of the cases in the edge-to-edge procedure with the MitraClip system to 100% of the cases in the IASd closure procedures. Indeed, in this last context, the advantages of transillumination with the light behind the IAS have been previously explored and can really increase the definition of the defects 11 . After reviewing the selected loops from different procedures, two independent observers with different experience in the field of interventional imaging and procedural guidance expressed a moderate-to-good agreement regarding the perceived added value of transillumination rendering.…”