Cor Vasa 2009, 51(5):334-339 | DOI: 10.33678/cor.2009.087

The contribution of real-time three-dimensional transesophageal echocardiography to intraoperative diagnosis in mitral regurgitant lesions

Josef Nečas^*, Sylva Kovalová, Helena Bedáňová, Petr Pokorný, Pavel Útrata, Jan Černý, Petr Němec, Jiří Ondrášek, Martin Hála

Centrum kardiovaskulární a transplantační chirurgie, Brno, Česká republika

Aim: To introduce a novel modality, real-time three dimensional transesophageal echocardiography (RT 3D TEE), into clinical practice and to evaluate its feasibility and impact on intraoperative morphological and hemodynamic diagnosis in mitral regurgitant lesions.
Material and method: During the year 2008, a total of 88 patients were investigated intraoperatively by RT 3D TEE together with conventional 2D method. The patient group comprised 57 men and 31 women with a wide variety of mitral regurgitant lesions (predominantly degenerative and ischemic). RT 3D TEE was carried out before and repeated immediately after heart surgery. We used "live" 3D clips and targeted 2D views for morphological assessment and ultra-short recordings and reconstruction for assessing mitral regurgitation using color flow mapping (CFM). All recordings were reviewed by an echocardiographer and the operating surgeon in order to assess ECHO and anatomical agreement.

Results: Very good image quality was achieved in 81 patients, fair quality in six, and poor in one patient. Identical image quality was observed in both 3D and 2D images. Full agreement between RT 3D images and surgical findings was obtained in 77 cases, while some differences were noted in 11 ones. The learning curve declined steadily over the year. RT 3D color flow mapping of regurgitant flows was excellent in all cases pointing exactly to the regurgitant orifice, showing direction and magnitude of regurgitant flow as well as the shape and behavior of the flow convergence region, which provides the best basis for quantifying mitral regurgitation.

Conclusions: RT 3D TEE in conjunction with targeted 2D cross sections provides the best depiction of mitral valve available. RT 3D -images are easy to understand even without greater experience in echocardiography. The cardiac surgeon has the opportunity to see the mitral valve in function over the whole heart cycle. The need for 3D reconstruction from 2D pictures in the imagination of the echo-cardiographer and surgeon approaches zero. RT 3D TEE CFM optimally shows mitral regurgitation in all its components.

Keywords: Real time 3D TEE; Intraoperative echocardiography; Mitral regurgitant lesions

Published: May 1, 2009  Show citation