CLINICAL RESEARCH: CARDIAC IMAGING
Head-to-Head Comparison of Two- and Three-Dimensional Transthoracic and Transesophageal Echocardiography in the Localization of Mitral Valve Prolapse
Mauro Pepi, MD*,
Gloria Tamborini, MD,
Anna Maltagliati, MD,
Claudia Agnese Galli, MD,
Erminio Sisillo, MD,
Luca Salvi, MD,
Moreno Naliato, MD,
Massimo Porqueddu, MD,
Alessandro Parolari, MD,
Marco Zanobini, MD and
Francesco Alamanni, MD
Centro Cardiologico Monzino, IRCCS, Department of Cardiology and Cardiac Surgery, University of Milan, Milan, Italy.
Manuscript received December 19, 2005;
revised manuscript received February 24, 2006,
accepted February 28, 2006.
* Reprint requests and correspondence: Dr. Mauro Pepi, Centro Cardiologico, Via Parea 4, 20138 Milan, Italy. (Email: mauro.pepi{at}cardiologicomonzino.it).
OBJECTIVES: The aim of this study, undertaken in patients who underwent mitral valve (MV) repair surgery, was to evaluate the feasibility and accuracy of 3-dimensional (3D) transthoracic (TTE) and transesophageal (TEE) echocardiography in the evaluation of MV pathology.
BACKGROUND: A pre-operative assessment of MV anatomy is essential to surgical design in patients undergoing MV repair. Although 2-dimensional (2D) echocardiography provides precise information regarding MV anatomy, 3D TTE and 3D TEE could increase the understanding of MV apparatus and individual scallop identification.
METHODS: One-hundred-twelve consecutive patients with severe mitral regurgitation due to MV prolapse underwent a complete 2D and 3D TTE the day before surgery and a complete 2D and 3D TEE in the operating room. Echocardiographic data obtained by the different techniques were compared with surgical inspection.
RESULTS: Three-dimensional techniques were feasible in a relatively short time (3D TTE: 7 ± 4 min; 3D TEE: 8 ± 3 min), with good (3D TTE 55%; 3D TEE 35%) and optimal (3D TTE 21%; 3D TEE 45%) imaging quality in the majority of cases. Three-dimensional TEE allowed more accurate identification (95.6% accuracy) of all MV lesions in comparison with other techniques. Three-dimensional TTE and 2D TEE had similar accuracies (90% and 87%, respectively), whereas the accuracy of 2D TTE (77%) was significantly lower.
CONCLUSIONS: Three-dimensional TTE and TEE are feasible and useful methods in identifying the location of MV prolapse. They were superior in the description of pathology in comparison with the corresponding 2D techniques and should be regarded as an important adjunct to standard 2D examinations in decisions regarding MV repair.
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Abbreviations and Acronyms
| | 2D = 2-dimensional | | 3D = 3-dimensional | | ALC = anterolateral commissure | | MV = mitral valve | | PMC = posteromedial commissure | | TEE = transesophageal echocardiography | | TTE = transthoracic echocardiography |
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