Use of a photo‐realism 3D rendering technique to enhance echocardiographic visualization of the anatomical details during beating‐heart mitral valve repair

Abstract

Mitral valve repair is the preferred treatment for patients with severe degenerative mitral valve regurgitation resulting from prolapsed mitral leaflets with or without chordal rupture. The NeoChord procedure is an innovative microinvasive, transventricular, beating-heart chordal replacement technique that is designed to replace ruptured or elongated chordae tendinae on the prolapsing segment of a mitral valve leaflet with artificial chordae made of expanded polytetrafluoroethylene (ePTFE). 1-3 The artificial chordae or neochordae are placed on the mitral leaflet, while the heart is beating using the DS1000 System (NeoChord, Inc St. Louis Park, MN). The DS1000 system is introduced via a transventricular approach through the distal, posterolateral wall of left ventricle. Preprocedure, use of three-dimensional (3D) transoesophageal (TOE) imaging is crucial for optimal patient selection. In addition, 3D TOE is critical for procedural navigation of the device and to confirm ePTFE chordal placement and positioning on the mitral leaflet. Awareness of the morphological details of the prolapsed mitral leaflet segment is an important consideration when assessing patient selection. However, understanding the change in morphological characteristics of the mitral leaflet segments during the procedure is also a key driver for successful outcomes. Use of real time 3D, with single beat acquisition, allows for visualization of the valvular anatomy and any related structural dysfunction with near-instantaneous volume-rendered reconstructions.Additionally, this 3D rendering technique avoids spatial motion artifacts by acquiring 3D volumetric datasets without requiring the need of cardiac or respiratory gating, single beat acquisition of datasets, that is, possible thanks to matrix phased-array transducer technology that includes the use of thousands of transmit-receive elements to generate the image volume. As such, real time 3D TOE

Intraoperative 3D TrueVue Transesophageal Echo Imaging in Cardiac Mass

“…TrueVue photorealistic 3D rendering is designed for better visualization of interventional devices and masses. [ 2 ] Advances in 3D echo with TrueVue technology allow more realistic imaging of cardiac structures, less drop out from thin structures, and a greater understanding of anatomical morphology. In 3D TrueVue mode, a virtual light source is used for simulating the interaction of light on 3-dimensional surfaces.…”

“…TrueVue illuminates tissue detail and creates depth perception in the anatomical reconstruction of the “surgeon view” of the surgical field; it is also possible to zoom inside the mass. [ 2 ] It can help with the communication of complicated echo images among caregivers in the operating room, providing a viewing context for the echo image to enhance procedural confidence.…”

Unearthing the Tunnel

“…The use of advanced TEE imaging software with a photorealism 3D-rendering technique and transillumination images with transparency enhanced the echocardiographic visualization of the complex geometry of the periannular channel, which could have been a sequela of his previous endocarditis. 4 , 5 In addition, placing the virtual light source above and around the mitral annulus, and the use of transillumination rendering, assisted in highlighting the exit and entrance of the periannular channel. 6 …”

Real-Time Monitoring and Step-by-Step Guidance for Transapical Mitral Valve Edge-to-Edge Repair Using Transesophageal Echocardiography

“…Recent advancement in TEE (X8-2t transducer, Philips Healthcare, Eindhoven, NL) provides increased resolution and tissue filling in 2D and real-time 3D visualization and meanwhile enables one-beat acquisitions with high volume rates in real-time 3D and 3D color flow Doppler (CFD) imaging. Photo-realistic 3D rendering techniques (TrueVue, Philips Healthcare, Eindhoven, NL) are designed to improve visualization of anatomical structures that appear pink-tored depending on the intracardiac position of a virtual light source [15,16].…”