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CLINICAL RESEARCH: CARDIAC IMAGING

Live 3-Dimensional Transesophageal Echocardiography

Initial Experience Using the Fully-Sampled Matrix Array Probe

Lissa Sugeng, MD, MPH^_*,_*, Stanton K. Shernan, MD, Ivan S. Salgo, MD, MS, Lynn Weinert, BS^_*, Doug Shook, MD, Jai Raman, MD, PhD^_*, Valluvan Jeevanandam, MD^_*, Frank DuPont, MD^_*, Scott Settlemier, BS, Bernard Savord, MS, John Fox, MD, Victor Mor-Avi, PhD^_* and Roberto M. Lang, MD^_*

^_* Departments of Medicine (Section of Cardiology), Cardiac Surgery, and Anesthesia and Critical Care, University of Chicago, Chicago, Illinois
Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
Philips Medical Systems, Andover, Massachusetts.

Manuscript received December 3, 2007; revised manuscript received April 10, 2008, accepted April 14, 2008.

^_* Reprint requests and correspondence: Dr. Lissa Sugeng, University of Chicago MC5084, 5841 South Maryland Avenue, Chicago, Illinois 60637. (Email: lsugeng{at}medicine.bsd.uchicago.edu).

Objectives: Our study goals were to evaluate the 3-dimensional matrix array transesophageal echocardiographic (3D-MTEE) probe by assessing the image quality of native valves and other intracardiac structures.

Background: Because 3-dimensional transesophageal echocardiography with gated rotational acquisition is not used routinely as the result of artifacts, lengthy acquisition, and processing, a 3D-MTEE probe was developed (Philips Medical Systems, Andover, Massachusetts).

Methods: In 211 patients, 3D-MTEE zoom images of the mitral valve (MV), aortic valve, tricuspid valve, interatrial septum, and left atrial appendage were obtained, followed by a left ventricular wide-angled acquisition. Images were reviewed and graded off-line (Xcelera with QLAB software, Philips Medical Systems).

Results: Excellent visualization of the MV (85% to 91% for all scallops of both MV leaflets), interatrial septum (84%), left atrial appendage (86%), and left ventricle (77%) was observed. Native aortic and tricuspid valves were optimally visualized only in 18% and 11% of patients, respectively.

Conclusions: The use of 3D-MTEE imaging, which is feasible in most patients, provides superb imaging of native MVs, which makes this modality an excellent choice for MV surgical planning and guidance of percutaneous interventions. Optimal aortic and tricuspid valve imaging will depend on further technological developments. Fast acquisition and immediate online display will facilitate wider acceptance and routine use in clinical practice.

Key Words: transesophageal echocardiography • 3-dimensional echocardiography • intraoperative echocardiography • mitral valve • valvular disease

Abbreviations and Acronyms   AV = aortic valve   IAS = interatrial septum   LAA = left atrial appendage   LV = left ventricle/ventricular   MTEE = matrix-array transesophageal echocardiography   MV = mitral valve   TEE = transesophageal echocardiography   TV = tricuspid valve