Utility of three-dimensional echocardiography during balloon mitral valvuloplasty

Applebaum, Robert M.; Kasliwal, Ravi R; Kanojia, Ajay; Seth, Ashok; Bhandari, Suman; Trehan, Naresh; Winer, Howard E.; Tunick, Paul A.; Kronzon, Itzhak

doi:10.1016/s0735-1097(98)00386-6

Cited by 71 publications

(28 citation statements)

References 19 publications

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“…Furthermore, it has also been reported that 3D may provide a better visualization of tear that can occur during PMC. 8 Thus RT3DE may guide and optimize PMC results by visualizing, during the procedure, the extent of commissural splitting so that maximal MVA can be achieved safely.…”

Section: Assessment Of Commissural Openingmentioning

confidence: 99%

“…The 3D shape of the mitral valve orifice is complex and preliminary data suggest that 3DE could visualize commissural splitting more accurately than 2DE. [8][9][10] In these series, a transoesophageal probe interfaced with a workstation was used. Clinical use of RT3DE (transthoracic imaging) for the assessment of the degree of commissural splitting has never been evaluated.…”

Section: Introductionmentioning

confidence: 99%

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Three-dimensional evaluation of the mitral valve area and commissural opening before and after percutaneous mitral commissurotomy in patients with mitral stenosis

Messika–Zeitoun

Brochet

Holmin

et al. 2006

European Heart Journal

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Aims Management of patients with mitral stenosis (MS) relies on accurate evaluation of the mitral valve area (MVA). Planimetry (MVA 2D ) is considered as the reference method but must be performed at the tips of the leaflets with the correct plane orientation and therefore requires experienced operators. Realtime three-dimensional echocardiography (RT3DE) may overcome this limitation but its usefulness for experienced when compared with less experienced operators has not been evaluated. In addition, superiority of RT3DE for the evaluation of commissural splitting after percutaneous mitral commissurotomy (PMC) is unknown. Methods and results 60 patients were prospectively evaluated by 2D and RT3DE before and after PMC by experienced operators. Before PMC, MVA 3D was slightly higher than MVA 2D (1.15 + 0.25 vs. 1.06 + 0.22 cm 2 , P ¼ 0.0001) but correlation between methods was excellent (r ¼ 0.73, P , 0.0001), mean difference was small (0.09 + 0.18 cm 2 ) and clinically meaningless (three patients misclassified, two of whom had borderline MS severity). After PMC, MVA 3D did not differ from and correlated well with MVA 2D (1.87 + 0.37 vs. 1.85 + 0.32 cm 2 , P ¼ 0.36; r ¼ 0.76, P , 0.0001; mean difference 0.03 + 0.24 cm 2 ). Twenty-five additional patients were also evaluated both by an experienced and a less experienced operators. Bland-Altman analysis showed the better agreement between MVA 3D measured by the less experienced operator and MVA 2D measured by the experienced operator than between MVA 2D measured by the less experienced and the experienced operators (mean difference 0.03 + 0.34 vs. 20.13 + 0.46 cm 2 , P ¼ 0.03). When compared with RT3DE, 2DE underestimated the degree of commissural opening in 33% of patients and agreement between methods was weak (k ¼ 0.41). Conclusion RT3DE provides accurate MVA measurements similar to 2D planimetry performed by experienced operators. Thus, it does not provide a real advantage for experienced operators, whereas it seems particularly helpful for less experienced operators. In addition, RT3DE improves the description of valvular anatomy.

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Section: Assessment Of Commissural Openingmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Three-dimensional evaluation of the mitral valve area and commissural opening before and after percutaneous mitral commissurotomy in patients with mitral stenosis

Messika–Zeitoun

Brochet

Holmin

et al. 2006

European Heart Journal

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“…It has been proved, that 3DE is better in the morphological assessment of the mechanism of mitral balloon valvuloplasty in comparison with 2DE [28]. Surface rendered 3DE images enable visualization of commissural splitting and leaflet tears not seen on 2DE.…”

Section: Discussionmentioning

confidence: 99%

New quantitative three-dimensional echocardiographic indices of mitral valve stenosis

Valočík

Kamp

Mannaerts

et al. 2007

Int J Cardiovasc Imaging

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Only moderate correlations between 3DE and Doppler-derived MVA's were observed. Measurement of the doming volume allows quantification of the 3DE geometry of the mitral apparatus. Patients with conical or funnel-like geometry are more likely to have sinus rhythm, whereas, patients with flat geometry are likely to have atrial fibrillation. Mitral valve volume can be used for the evaluation of mitral stenosis severity. These new 3DE indices might be used for selection of patients for balloon valvuloplasty.

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“…Furthermore, 3D TEE provides superior anatomic imaging of commissural calcification and fusion (Video 2), which is particularly important in patients undergoing PMBC, as well as detection of post-intervention commissural splitting and leaflet tears [75,77,78].…”

Section: Transesophageal Echocardiographymentioning

confidence: 99%

Assessment of Mitral Valve Disease: A Review of Imaging Modalities

Motiwala

Delling

2015

Curr Treat Options Cardio Med

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Mitral valve disease (MVD) related to mitral valve prolapse (MVP), coronary artery disease (CAD), and calcific mitral stenosis, is increasing in prevalence across the USA and Europe in the context of a longer life expectancy and aging population. In developing countries, rheumatic heart disease remains a major cause of MVD. Echocardiography represents the primary diagnostic modality for assessment of the mitral valve (MV). With the implementation of three-dimensional imaging, echocardiography has become an indispensable tool to evaluate the morphology, geometry, and function of the MV apparatus in the pre-operative setting. However, recognition of its limitations and advances in newer technologies have led to a growing interest in other imaging modalities such as cardiac magnetic resonance (CMR). Although still not widely available, CMR is an essential complement to echocardiography, especially when poor image quality, significant variability in flow diameter measurements, and geometric assumptions of flow orifice preclude accurate quantification of mitral regurgitation on echocardiographic images. In addition, CMR can reliably provide quantitative determination of ventricular volumes and function, hence facilitating surgical decision-making when serial linear echocardiographic measurements are discrepant. Finally, CMR assessment of fibrosis using late gadolinium enhancement allows better understanding of the interactions between MVD and the myocardium in both MVP and MVD related to CAD or other myopathy. In this review, we summarize the role of the available imaging modalities in understanding valvular pathology and determining severity of regurgitation or stenosis. Recently published valvular guidelines highlight the importance of monitoring MVD progression and the shift to intervention earlier in the course of disease. In this context, we also discuss the potential role of echocardiography and CMR in identifying early stages of MVD and/or pre-clinical markers of myocardial dysfunction.

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Utility of three-dimensional echocardiography during balloon mitral valvuloplasty

Abstract: The three-dimensional echocardiographic reconstruction enabled visualization of the mitral valve so that commissural splitting and leaflet tears not seen on the two-dimensional echocardiogram became visible.

Cited by 71 publications

References 19 publications

Three-dimensional evaluation of the mitral valve area and commissural opening before and after percutaneous mitral commissurotomy in patients with mitral stenosis

Three-dimensional evaluation of the mitral valve area and commissural opening before and after percutaneous mitral commissurotomy in patients with mitral stenosis

New quantitative three-dimensional echocardiographic indices of mitral valve stenosis

Assessment of Mitral Valve Disease: A Review of Imaging Modalities

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