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Son MJ, Chun EJ, Yoo SM, Lee SJ, White CS. Identification of Mitral Valve Prolapse on Non-electrocardiography-gated Enhanced Chest Computed Tomography. J Thorac Imaging 2023:00005382-990000000-00114. [PMID: 37982532 DOI: 10.1097/rti.0000000000000766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
PURPOSE The primary imaging modality for the diagnosis of mitral valve prolapse (MVP) is echocardiography supplemented by electrocardiography (ECG)-gated cardiac computed tomography (CT) angiography. However, we have recently encountered patients with MVP who were initially identified on non-ECG-gated enhanced chest CT. The purpose of this study is to evaluate the diagnostic accuracy of non-ECG-gated enhanced chest CT to predict the presence of MVP. PATIENTS AND METHODS Of 92 patients (surgically confirmed MVP who underwent non-ECG-gated chest CT), 27 patients were excluded for motion artifact or insufficient surgical correlation, and 65 patients were ultimately included. As a control, 65 patients with dyspnea and without MVP (non-ECG-gated chest CT and echocardiography were performed within 1 month) were randomly selected. We retrospectively analyzed an asymmetric double line sign on axial CT images for the presence of MVP. The asymmetric double line sign was defined as the presence of a linear structure, not located in the plane traversing the mitral annulus. RESULTS Use of the asymmetric double line sign to predict MVP on non-ECG-gated CT showed modest sensitivity, high specificity, modest negative predictive value, and high positive predictive value of 59% (38/65), 99% (64/65), 70% (64/91), and 97% (38/39), respectively. CONCLUSION The asymmetric double line sign on non-ECG-gated enhanced chest CT may be a valuable finding to predict the presence of MVP. Familiarity with this CT finding may lead to prompt diagnosis and proper management of MVP.
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Affiliation(s)
- Min Ji Son
- Department of Radiology, CHA University Bundang Medical Center, Bundang
| | - Eun Ju Chun
- Department of Radiology, Seoul National University Bundang Medical Center, Seongnam, Korea
| | - Seung Min Yoo
- Department of Radiology, CHA University Bundang Medical Center, Bundang
| | - Soo Jeong Lee
- Department of Radiology, CHA University Bundang Medical Center, Bundang
| | - Charles S White
- Department of Radiology, University of Maryland, Baltimore, MD
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Mantegazza V, Gripari P, Tamborini G, Muratori M, Fusini L, Ghulam Ali S, Garlaschè A, Pepi M. 3D echocardiography in mitral valve prolapse. Front Cardiovasc Med 2023; 9:1050476. [PMID: 36704460 PMCID: PMC9871497 DOI: 10.3389/fcvm.2022.1050476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 12/20/2022] [Indexed: 01/11/2023] Open
Abstract
Mitral valve prolapse (MVP) is the leading cause of mitral valve surgery. Echocardiography is the principal imaging modality used to diagnose MVP, assess the mitral valve morphology and mitral annulus dynamics, and quantify mitral regurgitation. Three-dimensional (3D) echocardiographic (3DE) imaging represents a consistent innovation in cardiovascular ultrasound in the last decades, and it has been implemented in routine clinical practice for the evaluation of mitral valve diseases. The focus of this review is the role and the advantages of 3DE in the comprehensive evaluation of MVP, intraoperative and intraprocedural monitoring.
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Affiliation(s)
- Valentina Mantegazza
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy,Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy,*Correspondence: Valentina Mantegazza ✉
| | - Paola Gripari
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Gloria Tamborini
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Manuela Muratori
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Laura Fusini
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy,Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Sarah Ghulam Ali
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Anna Garlaschè
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Mauro Pepi
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
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Adabifirouzjaei F, Hsiao A, DeMaria AN. Mitral Valve Prolapse-The Role of Cardiac Imaging Modalities. STRUCTURAL HEART : THE JOURNAL OF THE HEART TEAM 2022; 6:100024. [PMID: 37273735 PMCID: PMC10236887 DOI: 10.1016/j.shj.2022.100024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 10/22/2021] [Accepted: 10/28/2021] [Indexed: 06/06/2023]
Abstract
Mitral valve prolapse (MVP) is the most common nonischemic mitral regurgitation etiology and mitral abnormality requiring surgery in the Western world. There is an increasing awareness that pathological findings in MVP are not confined to the valve tissue; rather, it is a complex disease, involving the mitral valve apparatus, cardiac hemodynamics, and cardiac structure. Imaging has played a fundamental role in the understanding of the diagnosis, prevalence, and consequences of MVP. The diagnosis of MVP by imaging is based upon demonstrating valve leaflets ascending into the left atrium through the saddle-shaped annulus. Transthoracic and transesophageal echocardiography are the primary modalities in the diagnosis and assessment of MVP patients and must include careful assessment of the leaflets, annulus, chords, and papillary muscles. High-spatial-resolution imaging modalities such as cardiac magnetic resonance images and cardiac computed tomography play a secondary role in this regard and can demonstrate the anatomical relation between the mitral valve annulus and leaflet excursion for appropriate diagnosis. Ongoing development of new methods of cardiac imaging can help us to accurately understand the mechanism, diagnose the disease, develop an appropriate treatment plan, and estimate the risk for sudden death. Recently, several new observations with respect to prolapse have been derived from cardiac imaging including three-dimensional echocardiography and tissue-Doppler imaging. The aim of this article is to present these new imaging-derived insights for the diagnosis, risk assessment, treatment, and follow-up of patients with MVP.
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Affiliation(s)
- Fatemeh Adabifirouzjaei
- Department of Cardiology, Sulpizio Cardiovascular Center, University of California San Diego, San Diego, California, USA
| | - Albert Hsiao
- Department of Radiology, University of California San Diego, San Diego, California, USA
| | - Anthony N. DeMaria
- Department of Cardiology, Sulpizio Cardiovascular Center, University of California San Diego, San Diego, California, USA
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Italiano G, Fusini L, Mantegazza V, Tamborini G, Muratori M, Ghulam Ali S, Penso M, Garlaschè A, Gripari P, Pepi M. Novelties in 3D Transthoracic Echocardiography. J Clin Med 2021; 10:jcm10030408. [PMID: 33494387 PMCID: PMC7865963 DOI: 10.3390/jcm10030408] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 01/15/2021] [Accepted: 01/19/2021] [Indexed: 12/20/2022] Open
Abstract
Cardiovascular imaging is developing at a rapid pace and the newer modalities, in particular three-dimensional echocardiography, allow better analysis of heart structures. Identifying valve lesions and grading their severity represents crucial information and nowadays is strengthened by the introduction of new software, such as transillumination, which provide detailed morphology descriptions. Chambers quantification has never been so rapid and accurate: machine learning algorithms generate automated volume measurements, including left ventricular systolic and diastolic function, which is extremely important for clinical decisions. This review provides an overview of the latest innovations in the echocardiography field, and is helpful by providing a better insight into heart diseases.
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Gripari P, Mapelli M, Bellacosa I, Piazzese C, Milo M, Fusini L, Muratori M, Ali SG, Tamborini G, Pepi M. Transthoracic echocardiography in patients undergoing mitral valve repair: comparison of new transthoracic 3D techniques to 2D transoesophageal echocardiography in the localization of mitral valve prolapse. Int J Cardiovasc Imaging 2018; 34:1099-1107. [PMID: 29484557 DOI: 10.1007/s10554-018-1324-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 02/22/2018] [Indexed: 11/27/2022]
Abstract
Successful mitral valve (MV) repair for degenerative mitral regurgitation (DMR) is mainly related to surgical expertise and MV anatomy. Although 2D echocardiography, specifically transoesophageal (TOE), provides precise information regarding MV anatomy, recent advancements in matrix technology meant a decisive step forward to the point where segmental MV analysis can be accurately performed from a noninvasive 3D transthoracic (TTE) approach. The aims of this study were: (a) to evaluate the feasibility and time required for real-time 3D TTE in a large consecutive cohort of patients with severe DMR in the assessment of MV anatomy; (b) to compare the accuracy of 3D TTE and 2D TOE versus surgical inspection in the recognition and localization of all components of the MV leaflets; (c) to establish the added diagnostic value of 3D colourDoppler examination to pure 3D morphologic evaluation. 149 consecutive patients with severe DMR underwent complete 3D TTE before surgery and 2D TOE in the operating room. Echocardiographic data obtained by the different techniques were compared with surgical inspection. 3D TTE was feasible in a relatively short time (8 ± 4 min), with good (49%) and optimal (33%) imaging quality in the majority of cases. 3D TTE had significant better overall accuracy compared to 2D TOE (93 and 91%, p < 0.05, respectively). 2D TOE was significantly more specific than 3D TTE in the identification of A3 prolapse (99 vs. 96%). The colourDoppler mode did not improve significantly the accuracy of 3D TTE, albeit it determined a better sensitivity in the detection of A2 prolapse if compared to 2D TOE (95 vs. 85%). 3D TTE with or without colourDoppler is a feasible and useful method in the analysis of MV prolapse; it allows a preoperative and noninvasive description of the pathology as accurate as the 2D TOE.
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Affiliation(s)
- Paola Gripari
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, Via Parea 4, 20138, Milan, Italy.
| | - Massimo Mapelli
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, Via Parea 4, 20138, Milan, Italy
| | - Ilaria Bellacosa
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, Via Parea 4, 20138, Milan, Italy
| | - Concetta Piazzese
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, Via Parea 4, 20138, Milan, Italy
| | - Maria Milo
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, Via Parea 4, 20138, Milan, Italy
| | - Laura Fusini
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, Via Parea 4, 20138, Milan, Italy
| | - Manuela Muratori
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, Via Parea 4, 20138, Milan, Italy
| | - Sarah Ghulam Ali
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, Via Parea 4, 20138, Milan, Italy
| | - Gloria Tamborini
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, Via Parea 4, 20138, Milan, Italy
| | - Mauro Pepi
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, Via Parea 4, 20138, Milan, Italy
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McGhie JS, de Groot-de Laat L, Ren B, Vletter W, Frowijn R, Oei F, Geleijnse ML. Transthoracic two-dimensional xPlane and three-dimensional echocardiographic analysis of the site of mitral valve prolapse. Int J Cardiovasc Imaging 2015; 31:1553-60. [PMID: 26276508 PMCID: PMC4651983 DOI: 10.1007/s10554-015-0734-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 08/03/2015] [Indexed: 02/07/2023]
Abstract
This study sought to assess the value of two-dimensional (2D) transthoracic echocardiography (TTE), 2D xPlane imaging and three-dimensional (3D) TTE for the definition of the site and the extent of mitral valve (MV) prolapse. Fifty patients underwent transthoracic 2D, 2D xPlane and 3D echocardiography. With 2D xPlane a segmental analysis of the MV was performed, by making a lateral sweep across the MV coaptation line as seen in the parasternal short-axis view. Inter-observer agreement for specific scallop prolapse was for 2D xPlane excellent (97 %, kappa = 0.94) and for 3D TTE moderate (85 %, kappa = 0.67). The respective sensitivities of standard 2D TTE, 2D xPlane, and 3D TTE for the identification of the precise posterior scallop prolapse were for P1 92, 85, and 92 %, for P2 96, 96, and 82 %, and for P3 86, 81, and 71 %. In total, 5 (8 %) prolapsing MV scallops were missed by 2D TTE, 7 (12 %) by 2D xPlane, and 12 (20 %) by 3D TTE. The sensitivity of 3D TTE was significantly lower than standard 2D imaging (80 % versus 93 %, P < 0.05). The extent of P2 prolapse was under or overestimated in 5 patients with 2D xPlane and in 9 patients with 3D TTE. 2D xPlane imaging is an accurate, easy to use (compared to 3D TTE) and easy to interpret (compared to 2D and 3D TTE) imaging modality to study the site and the extent of MV prolapse.
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Affiliation(s)
- Jackie S McGhie
- Department of Cardiology, The Thoraxcenter, Erasmus University Medical Center, Room BA 302, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
| | - Lotte de Groot-de Laat
- Department of Cardiology, The Thoraxcenter, Erasmus University Medical Center, Room BA 302, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - Ben Ren
- Department of Cardiology, The Thoraxcenter, Erasmus University Medical Center, Room BA 302, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - Wim Vletter
- Department of Cardiology, The Thoraxcenter, Erasmus University Medical Center, Room BA 302, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - René Frowijn
- Department of Cardiology, The Thoraxcenter, Erasmus University Medical Center, Room BA 302, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - Frans Oei
- Department of Cardiology, The Thoraxcenter, Erasmus University Medical Center, Room BA 302, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - Marcel L Geleijnse
- Department of Cardiology, The Thoraxcenter, Erasmus University Medical Center, Room BA 302, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
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7
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Assessment of Mitral Valve Disease: A Review of Imaging Modalities. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2015; 17:390. [DOI: 10.1007/s11936-015-0390-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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8
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Singh GD, Smith TW, Rogers JH. Multi-MitraClip therapy for severe degenerative mitral regurgitation: “Anchor” technique for extremely flail segments. Catheter Cardiovasc Interv 2015; 86:339-46. [DOI: 10.1002/ccd.25811] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 11/07/2014] [Accepted: 12/25/2014] [Indexed: 11/08/2022]
Affiliation(s)
- Gagan D. Singh
- Division of Cardiovascular Medicine; University of California Davis Medical Center; Sacramento California
| | - Thomas W. Smith
- Division of Cardiovascular Medicine; University of California Davis Medical Center; Sacramento California
| | - Jason H. Rogers
- Division of Cardiovascular Medicine; University of California Davis Medical Center; Sacramento California
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9
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Akhter N, Zhao Q, Andrei AC, Kane B, McCarthy P, Rigolin VH. Identification of prolapsing mitral valve scallops by a three-dimensional multiplanar reconstruction method. Echocardiography 2014; 32:106-13. [PMID: 24702674 DOI: 10.1111/echo.12608] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The objectives of this study were twofold: to assess the diagnostic utility of three-dimensional (3D) multiplanar reconstruction (MPR) in identifying prolapsing mitral valve (MV) scallops, and (2) to compare two-dimensional (2D) transthoracic echocardiography (TTE) and 3DMPR to (2D) transesophageal echocardiography (TEE) approaches among patients with mitral valve prolapse (MVP). METHODS Fifty-five patients with MVP who underwent MV repair or replacement were retrospectively analyzed using 3 types of echocardiographic studies (2DTEE, 2DTTE, 3DMPR). The operative (OR) findings were considered the gold standard. RESULTS When 3DMPR was combined with 2DTTE, the agreement with the OR findings was moderately strong for the A2 scallop (P < 0.001) and strong for the A3 scallop (P = 0.001), entire anterior leaflet (P < 0.001), P2 scallop (P < 0.001) and the entire posterior leaflet (P < 0.001). In comparison to the OR findings, 2DTEE demonstrated moderately strong agreement for the A2 scallop (P = 0.010) and the entire anterior leaflet (P < 0.001), and strong agreement for the P2 scallop (P < 0.001) and entire posterior leaflet (P < 0.001). CONCLUSIONS Three-dimensional MPR should be added to the armamentarium of complementary echo techniques in the evaluation of MVP. There is increased benefit in combining 3DMPR with 2DTTE findings as part of the preoperative evaluation of patients with MVP.
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Affiliation(s)
- Nausheen Akhter
- Divisions of Cardiology and Cardiothoracic Surgery, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Gripari P, Muratori M, Fusini L, Tamborini G, Pepi M. Three-Dimensional Echocardiography: Advancements in Qualitative and Quantitative Analyses of Mitral Valve Morphology in Mitral Valve Prolapse. J Cardiovasc Echogr 2014; 24:1-9. [PMID: 28465897 PMCID: PMC5353406 DOI: 10.4103/2211-4122.131985] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
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.
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Affiliation(s)
- Paola Gripari
- Centro Cardiologico Monzino, Istituto di ricovero e cura a carattere scientifico, Milano, Italy
| | - Manuela Muratori
- Centro Cardiologico Monzino, Istituto di ricovero e cura a carattere scientifico, Milano, Italy
| | - Laura Fusini
- Centro Cardiologico Monzino, Istituto di ricovero e cura a carattere scientifico, Milano, Italy
| | - Gloria Tamborini
- Centro Cardiologico Monzino, Istituto di ricovero e cura a carattere scientifico, Milano, Italy
| | - Mauro Pepi
- Centro Cardiologico Monzino, Istituto di ricovero e cura a carattere scientifico, Milano, Italy
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Maffessanti F, Tamborini G, Fusini L, Stevanella M, Sotaquira M, Caiani E, Pepi M. Advances in echocardiography: insights into the mitral valve and implications for surgical and percutaneous repair. Interv Cardiol 2013. [DOI: 10.2217/ica.13.50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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12
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Maffessanti F, Mirea O, Tamborini G, Pepi M. Three-dimensional echocardiography of the mitral valve: lessons learned. Curr Cardiol Rep 2013; 15:377. [PMID: 23686753 DOI: 10.1007/s11886-013-0377-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Three-dimensional echocardiography has markedly improved our understanding of normal and pathologic mitral valve (MV) mechanics. Qualitative and quantitative analysis of three-dimensional (3D) data on the mitral valve could have a clinical impact on diagnosis, patient referral, surgical strategies, annuloplasty ring design and evaluation of the immediate and long-term surgical outcome. This review covers the contribution of 3D echocardiography in the diagnosis of MV disease, its role in selecting and monitoring surgical procedures, and in the assessment of surgical outcomes. Moreover, advantages of this technique versus the standard 2D modality, as well as future applications of advanced analysis techniques, will be reviewed.
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Abstract
The aim of this article is to provide a perspective on the relative importance and contribution of different imaging modalities in patients with valvular heart disease. Valvular heart disease is increasing in prevalence across Europe, at a time when the clinical ability of physicians to diagnose and assess severity is declining. Increasing reliance is placed on echocardiography, which is the mainstay of cardiac imaging in valvular heart disease. This article outlines the techniques used in this context and their limitations, identifying areas in which dynamic imaging with cardiovascular magnetic resonance and multislice CT are expanding.
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Affiliation(s)
- W S Choo
- Penang Medical College, Georgetown, Malaysia
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14
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Anwar AM, Nosir YFM, Zainal-Abidin SK, Ajam A, Chamsi-Pasha H. Real-time three-dimensional transthoracic echocardiography in daily practice: initial experience. Cardiovasc Ultrasound 2012; 10:14. [PMID: 22448671 PMCID: PMC3350441 DOI: 10.1186/1476-7120-10-14] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2012] [Accepted: 03/26/2012] [Indexed: 11/10/2022] Open
Abstract
AIM OF THE WORK To evaluate the feasibility and possible additional value of transthoracic real-time three-dimensional echocardiography (RT3D-TTE) for the assessment of cardiac structures as compared to 2D-TTE. METHODS 320 patients (mean age 45 ± 8.4 years, 75% males) underwent 2D-TTE and RT3D-TTE using 3DQ-Q lab software for offline analysis. Volume quantification and functional assessment was performed in 90 patients for left ventricle and in 20 patients for right ventricle. Assessment of native (112 patients) and prosthetic (30 patients) valves morphology and functions was performed. RT3D-TTE was performed for evaluation of septal defects in 30 patients and intracardiac masses in 52 patients. RESULTS RT3D-TTE assessment of left ventricle was feasible and reproducible in 86% of patients while for right ventricle, it was (55%). RT3D-TTE could define the surface anatomy of mitral valve optimally (100%), while for aortic and tricuspid was (88% and 81% respectively). Valve area could be planimetered in 100% for the mitral and in 80% for the aortic. RT3D-TTE provided a comprehensive anatomical and functional evaluation of prosthetic valves. RT3D-TTE enface visualization of septal defects allowed optimal assessment of shape, size, area and number of defects and evaluated the outcome post device closure. RT3D-TTE allowed looking inside the intracardiac masses through multiple sectioning, valuable anatomical delineation and volume calculation. CONCLUSION Our initial experience showed that the use of RT3D-TTE in the assessment of cardiac patients is feasible and allowed detailed anatomical and functional assessment of many cardiac disorders.
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Affiliation(s)
- Ashraf M Anwar
- Department of Cardiology, King Fahd Armed Forces Hospital, P,O, Box: 9862, Jeddah 21159, Saudi-Arabia.
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Bonnichsen CR, Burkhart HM, Klarich KW, Suri RM. Surgical Resection of Mitral Valve Papillary Fibroelastoma: A Robot-Assisted, Minimally Invasive Approach with Three-Dimensional Transesophageal Echocardiography Imaging. ACTA ACUST UNITED AC 2012. [DOI: 10.4236/wjcs.2012.22004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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16
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Ben Zekry S, Nagueh SF, Little SH, Quinones MA, McCulloch ML, Karanbir S, Herrera EL, Lawrie GM, Zoghbi WA. Comparative Accuracy of Two- and Three-Dimensional Transthoracic and Transesophageal Echocardiography in Identifying Mitral Valve Pathology in Patients Undergoing Mitral Valve Repair: Initial Observations. J Am Soc Echocardiogr 2011; 24:1079-85. [DOI: 10.1016/j.echo.2011.06.011] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Indexed: 11/26/2022]
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17
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Pepi M, Tamborini G, Fusini L, Maffessanti F. Three-dimensional echocardiography and mitral valve prolapse diagnosis: new insights into leaflet and cardiac chamber morphology, and annulus dynamics. J Cardiovasc Echogr 2011. [DOI: 10.1016/j.jcecho.2011.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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18
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Saito K, Okura H, Watanabe N, Imai K, Tamada T, Koyama T, Hayashida A, Neishi Y, Kawamoto T, Yoshida K. Quantification of mitral valve apparatus by three-dimensional transesophageal echocardiography: in vitro validation study comparing two different analysis systems. J Echocardiogr 2011; 9:130-6. [PMID: 27277289 DOI: 10.1007/s12574-011-0091-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Revised: 04/04/2011] [Accepted: 04/12/2011] [Indexed: 11/28/2022]
Affiliation(s)
- Ken Saito
- Department of Cardiology, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan.
| | - Hiroyuki Okura
- Department of Cardiology, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan
| | - Nozomi Watanabe
- Department of Cardiology, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan
| | - Koichiro Imai
- Department of Cardiology, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan
| | - Tomoko Tamada
- Department of Cardiology, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan
| | - Terumasa Koyama
- Department of Cardiology, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan
| | - Akihiro Hayashida
- Department of Cardiology, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan
| | - Yoji Neishi
- Department of Cardiology, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan
| | - Takahiro Kawamoto
- Department of Cardiology, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan
| | - Kiyoshi Yoshida
- Department of Cardiology, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan
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La Canna G, Arendar I, Maisano F, Monaco F, Collu E, Benussi S, De Bonis M, Castiglioni A, Alfieri O. Real-time three-dimensional transesophageal echocardiography for assessment of mitral valve functional anatomy in patients with prolapse-related regurgitation. Am J Cardiol 2011; 107:1365-74. [PMID: 21371680 DOI: 10.1016/j.amjcard.2010.12.048] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2010] [Revised: 12/17/2010] [Accepted: 12/17/2010] [Indexed: 11/27/2022]
Abstract
The aim of the study was to evaluate the additional diagnostic value of real-time 3-dimensional transesophageal echocardiography (RT3D-TEE) for surgically recognized mitral valve (MV) prolapse anatomy compared to 2-dimensional transthoracic echocardiography (2D-TTE), 2D-transesophageal echocardiography (2D-TEE), and real-time 3D-transthoracic echocardiography (RT3D-TTE). We preoperatively analyzed 222 consecutive patients undergoing repair for prolapse-related mitral regurgitation using RT3D-TEE, 2D-TEE, RT3D-TTE, and 2D-TTE. Multiplanar reconstruction was added to volume-rendered RT3D-TEE for quantitative prolapse recognition. The echocardiographic data were compared to the surgical findings. Per-patient analysis of RT3D-TEE identified prolapse in 204 patients more accurately (92%) than 2D-TEE (78%), RT3D-TTE (80%), and 2D-TTE (54%). Even among those 60 patients with complex prolapse (>1 segment localization or commissural lesions), RT3D-TEE correctly identified 58 (96.5%) compared to 42 (70%), 31 (52%), and 21 (35%) detected by 2D-TEE, RT3D-TTE, and 2D-TTE (p < 0.0001). Multiplanar reconstruction enabled RT3D-TEE to differentiate dominant (≥5-mm displacement) and secondary (2 to <5-mm displacement) prolapsed segments in agreement with surgically recognized dominant lesions (100%), but with a low predictive value (34%) for secondary lesions. In addition, owing to the identification of clefts and subclefts (indentations of MV tissue that extended ≥50% or <50% of the total leaflet height, respectively), RT3D-TEE accurately characterized the MV anatomy, including that which deviated from the standard nomenclature. In conclusion, RT3D-TEE provided more accurate mapping of MV prolapse than 2D imaging and RT3D-TTE, adding quantitative recognition of dominant and secondary lesions and MV anatomy details.
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Quantitative Analysis of Mitral Valve Apparatus in Mitral Valve Prolapse Before and After Annuloplasty: A Three-Dimensional Intraoperative Transesophageal Study. J Am Soc Echocardiogr 2011; 24:405-13. [DOI: 10.1016/j.echo.2011.01.012] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2010] [Indexed: 11/16/2022]
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21
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Jassar AS, Brinster CJ, Vergnat M, Robb JD, Eperjesi TJ, Pouch AM, Cheung AT, Weiss SJ, Acker MA, Gorman JH, Gorman RC, Jackson BM. Quantitative mitral valve modeling using real-time three-dimensional echocardiography: technique and repeatability. Ann Thorac Surg 2011; 91:165-71. [PMID: 21172507 DOI: 10.1016/j.athoracsur.2010.10.034] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2010] [Revised: 10/13/2010] [Accepted: 10/18/2010] [Indexed: 11/19/2022]
Abstract
BACKGROUND Real-time three-dimensional (3D) echocardiography has the ability to construct quantitative models of the mitral valve (MV). Imaging and modeling algorithms rely on operator interpretation of raw images and may be subject to observer-dependent variability. We describe a comprehensive analysis technique to generate high-resolution 3D MV models and examine interoperator and intraoperator repeatability in humans. METHODS Patients with normal MVs were imaged using intraoperative transesophageal real-time 3D echocardiography. The annulus and leaflets were manually segmented using a TomTec Echo-View workstation. The resultant annular and leaflet point cloud was used to generate fully quantitative 3D MV models using custom Matlab algorithms. Eight images were subjected to analysis by two independent observers. Two sequential images were acquired for 6 patients and analyzed by the same observer. Each pair of annular tracings was compared with respect to conventional variables and by calculating the mean absolute distance between paired renderings. To compare leaflets, MV models were aligned so as to minimize their sum of squares difference, and their mean absolute difference was measured. RESULTS Mean absolute annular and leaflet distance was 2.4±0.8 and 0.6±0.2 mm for the interobserver and 1.5±0.6 and 0.5±0.2 mm for the intraobserver comparisons, respectively. There was less than 10% variation in annular variables between comparisons. CONCLUSIONS These techniques generate high-resolution, quantitative 3D models of the MV and can be used consistently to image the human MV with very small interoperator and intraoperator variability. These data lay the framework for reliable and comprehensive noninvasive modeling of the normal and diseased MV.
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Affiliation(s)
- Arminder Singh Jassar
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
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22
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Three-Dimensional Echocardiography in Adult Congenital Heart Disease. CURRENT CARDIOVASCULAR IMAGING REPORTS 2010. [DOI: 10.1007/s12410-010-9038-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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23
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Papel del ecocardiograma en la reparación mitral. CIRUGIA CARDIOVASCULAR 2010. [DOI: 10.1016/s1134-0096(10)70082-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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24
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Nemes A, Geleijnse ML, Soliman OII, Vletter WB, McGhie JS, Forster T, Ten Cate FJ. [Evaluation of the mitral valve by transthoracic real-time three-dimensional echocardiography]. Orv Hetil 2010; 151:854-63. [PMID: 20462845 DOI: 10.1556/oh.2010.28874] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Recently, echocardiography is the most widely used routine non-invasive diagnostic method, with which morphology and function of the mitral valve can be characterized. The aim of this review is to demonstrate the role of one of the newest echocardiographic developments, the transthoracic real-time three-dimensional echocardiography in the evaluation of mitral valve.
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Affiliation(s)
- Attila Nemes
- Erasmus MC, Thoraxcentrum, Kardiológiai Klinika, Rotterdam.
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25
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Tamborini G, Muratori M, Maltagliati A, Galli CA, Naliato M, Zanobini M, Alamanni F, Salvi L, Sisillo E, Fiorentini C, Pepi M. Pre-operative transthoracic real-time three-dimensional echocardiography in patients undergoing mitral valve repair: accuracy in cases with simple vs. complex prolapse lesions. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2010; 11:778-85. [PMID: 20488814 DOI: 10.1093/ejechocard/jeq066] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
AIMS The aim of this study, undertaken in patients who underwent mitral valve (MV) repair surgery, was to evaluate the accuracy of pre-operative three-dimensional (3D) transthoracic echocardiography (TTE) in the evaluation of MV pathology in cases with simple or complex lesions. METHODS AND RESULTS Two hundred consecutive patients with severe mitral regurgitation due to degenerative MV prolapse underwent a complete 3DTTE the day before surgery. Three-dimensional TTE data were compared with MV surgical inspection. Three-dimensional echocardiography was feasible in a relatively short time (5 ± 3 min) with good (67%) and optimal (21%) imaging quality in the majority of cases. Three-dimensional TTE allowed an accurate identification (95% accuracy) of all MV lesions. Seventy-three (36.5%) patients had simple lesions at 3DTTE and 71 of them (97.2%) underwent a simple surgical procedure; 127 (63.5%) had complex lesions at 3DTTE and, in these cases, surgeons performed either simple procedures (48%) or complex procedures (47.2%) or valve replacement in 4.7% (after a first attempt for repair). CONCLUSION Three-dimensional TTE is feasible, not time-consuming, and accurate in identifying cases with simple vs. complex MV lesions.
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Affiliation(s)
- Gloria Tamborini
- Centro Cardiologico Monzino, IRCCS, Department of Cardiovascular Sciences, University of Milan, Via Parea 4, 20138 Milan, Italy.
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26
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Gripari P, Tamborini G, Barbier P, Maltagliati AC, Galli CA, Muratori M, Salvi L, Sisillo E, Alamanni F, Pepi M. Real-time three-dimensional transoesophageal echocardiography: a new intraoperative feasible and useful technology in cardiac surgery. Int J Cardiovasc Imaging 2010; 26:651-60. [PMID: 20352342 DOI: 10.1007/s10554-010-9622-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2009] [Accepted: 03/11/2010] [Indexed: 10/19/2022]
Abstract
A new generation of transoesophageal echocardiographic probes with a novel matrix array technique has been recently introduced, allowing three-dimensional (3D) presentation of cardiac structures in real-time. This new tool may potentially provide fast and complete 3D information about cardiac structures improving spatial orientation and overcoming limitations of offline 3D technologies. The aim of this study was to demonstrate the feasibility and usefulness of real-time 3D transoesophageal echocardiography (TOE) for the intraoperative evaluation of cardiac surgery procedures. One-hundred patients underwent transoesophageal echocardiographic examination during cardiac surgery as a part of their routine clinical practice. In the intraoperative pre- and post-cardiopulmonary bypass periods complete 2D and 3D transoesophageal examinations were performed. Feasibility and duration of examinations, and immediate additional anatomical value of 3D versus 2D-TOE were annotated intraoperatively. Image quality, additional clinical value of 3D- compared to standard 2D-TOE and the accuracy in the description of mitral valve pathology by a surgeon and an echocardiographer were evaluated off-line. No complications related to transoesophageal examination occurred and successful intubation was achieved in all 100 patients. Therefore, 200 examinations were performed and analysed considering the pre- and post-cardiopulmonary bypass periods. The mean number of acquisitions per patient was 16 +/- 14, including 3D real-time, zoom, full-volume and colour full volume modalities. The duration of the 3D examination was 16 +/- 10 min and the mean image quality score 2.8 +/- 0.7 (in a scale 1-4). In 36 out of 100 cases (36%) 3D-TOE provided additional anatomical information. The surgeon evaluated 3D images easier and more accurately than 2D images (88% vs. 76% in the evaluation of mitral valve scallop). Real-time 3D TOE may be used routinely for the intraoperative evaluation of cardiac surgery. Imaging with this new probe facilitates intraoperative evaluation of several surgical procedures with an additional clinical value in selected cases.
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Affiliation(s)
- Paola Gripari
- Centro Cardiologico Monzino, IRCCS, Department of Cardiovascular Sciences, University of Milan, Via Parea 4, Milan, Italy.
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Feuchtner GM, Alkadhi H, Karlo C, Sarwar A, Meier A, Dichtl W, Leschka S, Blankstein R, Gruenenfelder J, Stolzmann P, Cury RC. Cardiac CT Angiography for the Diagnosis of Mitral Valve Prolapse: Comparison with Echocardiography . Radiology 2010; 254:374-383. [DOI: 10.1148/radiol.2541090393] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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28
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Obase K, Watanabe N, Yoshida K. Real-time three-dimensional echocardiographic evaluation of the mitral valve. CURRENT CARDIOVASCULAR IMAGING REPORTS 2009. [DOI: 10.1007/s12410-009-0047-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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29
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Salcedo EE, Quaife RA, Seres T, Carroll JD. A Framework for Systematic Characterization of the Mitral Valve by Real-Time Three-Dimensional Transesophageal Echocardiography. J Am Soc Echocardiogr 2009; 22:1087-99. [PMID: 19801300 DOI: 10.1016/j.echo.2009.07.007] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2009] [Indexed: 11/28/2022]
Affiliation(s)
- Ernesto E Salcedo
- University of Colorado Denver, Denver, Colorado, Aurora, CO 80045, USA.
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30
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Beraud AS, Schnittger I, Miller DC, Liang DH. Multiplanar reconstruction of three-dimensional transthoracic echocardiography improves the presurgical assessment of mitral prolapse. J Am Soc Echocardiogr 2009; 22:907-13. [PMID: 19553082 DOI: 10.1016/j.echo.2009.05.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2009] [Indexed: 11/27/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the value and accuracy of multiplanar reconstruction (MPR) of three-dimensional (3D) transthoracic echocardiographic data sets in assessing mitral valve pathology in patients with surgical mitral valve prolapse (MVP). METHODS Sixty-four patients with surgical MVP and preoperative two-dimensional (2D) and 3D transthoracic echocardiography were analyzed. The descriptions obtained by 3D MPR and 2D were compared in the context of the surgical findings. RESULTS Two-dimensional echocardiography correctly identified the prolapsing leaflets in 32 of 64 patients and 3D MPR in 46 of 64 patients (P=.016). Among the 27 patients with complex pathology (ie, more than isolated middle scallop of the posterior leaflet prolapse), 3D MPR identified 20 correctly, as opposed to 6 with 2D imaging (P<.001). CONCLUSION Interpretation of 3D transthoracic echocardiographic images with MPR improved the accuracy of the description of the MVP compared with 2D interpretation. This added value of 3D MPR was most important in extensive and/or commissural prolapse.
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Affiliation(s)
- Anne-Sophie Beraud
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, and Stanford Hospital, Stanford, California 94303, USA.
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31
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Solis J, Sitges M, Levine RA, Hung J. Ecocardiografía tridimensional. Nuevas perspectivas sobre la caracterización de la válvula mitral. Rev Esp Cardiol 2009. [DOI: 10.1016/s0300-8932(09)70161-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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32
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Real Time Transthoracic Three-Dimensional Echocardiography: How Should it be Applied in the Clinical Setting? J Med Ultrasound 2009. [DOI: 10.1016/s0929-6441(09)60113-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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33
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Jungwirth B, Mackensen GB. Real-time 3-dimensional echocardiography in the operating room. Semin Cardiothorac Vasc Anesth 2008; 12:248-64. [PMID: 19033269 DOI: 10.1177/1089253208328669] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Real-time 3-dimensional transesophageal echocardiography (RT-3D-TEE) represents a novel clinical and intuitively educational perioperative cardiovascular imaging modality. The development of RT-3D-TEE allows for live 3D imaging as it circumvents most of the disadvantages of reconstructive 3D methods. RT-3D-TEE will likely revolutionize perioperative assessment of complex 3D structures, such as the mitral valve (MV), as it provides important mechanistic insights into functional and ischemic mitral regurgitation. The MV is particularly suited to live RT-3D-TEE assessment because of the complex interrelationships among the valve, chordae, papillary muscles, and myocardial walls. The 3D en face view of the MV is in accordance with the surgical view and allows to illustrate the unique saddle shape of the MV annulus and to define and localize mitral leaflet lesions in MV prolapse, endocarditis, or congenital MV abnormalities, all potentially important in guiding surgical repair. RT-3D-TEE will soon be integrated into routine perioperative practice. Its unique ability of real-time acquisition, online rendering and cropping capabilities, accurate identification of the precise pathology and location of cardiac disease, together with its ability to promptly quantify 3D data sets using built-in software, will likely help in transitioning this modality into standard of care.
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Affiliation(s)
- Bettina Jungwirth
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina 27710, USA
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Abstract
PURPOSE OF REVIEW To highlight the relevance of preoperative differentiation of degenerative mitral valve disease based on etiology (predominantly Barlow's Disease or fibroelastic deficiency) and severity of lesions with an emphasis on how such differentiation by the cardiologist can result in increased rate of mitral valve repair. RECENT FINDINGS In the hands of reference mitral valve-repair surgeons, 95-100% of degenerative valves are repairable, regardless of etiology; however, in the general cardiac surgical community, the repair rates are around 50%. In contrast to fibroelastic deficiency, Barlow's valves have more complex pathology and require advanced techniques to effect a repair. We present a simple algorithm that enables the cardiologist to stratify degenerative mitral valves into those that are repairable by any experienced cardiac surgeon and those that require reference-center referral to deliver a high probability of repair. Such targeted referral strategy should result in near 100% repair rate for degenerative disease. SUMMARY Essentially, all degenerative mitral valves are repairable. By matching echocardiographic findings to the appropriate surgical skill level required to consistently deliver a repair, valve replacement for degenerative mitral valve disease should be infrequent.
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35
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Kondur A, Pitta S, Afonso L. Incremental utility of real-time three-dimensional echocardiography in the diagnosis and preoperative assessment of cleft mitral valve in adults. ACTA ACUST UNITED AC 2008; 9:586-8. [DOI: 10.1093/ejechocard/jen109] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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