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CLINICAL RESEARCH: CARDIAC IMAGING

Real-Time 3-Dimensional Transesophageal Echocardiography in the Evaluation of Post-Operative Mitral Annuloplasty Ring and Prosthetic Valve Dehiscence

Itzhak Kronzon, MD^_*, Lissa Sugeng, MD, Gila Perk, MD^_*,_*, David Hirsh, MD^_*, Lynn Weinert, RDCS, Miguel Angel Garcia Fernandez, MD and Roberto M. Lang, MD

^_* NYU School of Medicine, New York, New York
University of Chicago Medical Center, Chicago, Illinois
Hospital General Universitario, Gregorio Maranon, Madrid, Spain

Manuscript received November 3, 2008; revised manuscript received December 9, 2008, accepted December 23, 2008.

^_* Reprint requests and correspondence: Dr. Gila Perk, Non-Invasive Cardiology, NYU School of Medicine, 550 First Avenue, TH-2, HW-228, New York, New York 10016 (Email: gila.perk{at}nyumc.org).

Objectives: This study sought to assess the use of real-time (RT) 3-dimensional (3D) transthoracic and transesophageal echocardiography (TEE) in the evaluation of post-operative mitral valve dehiscence.

Background: Mitral valve replacement or repair may be complicated by post-operative dehiscence of the valve or annuloplasty ring resulting in clinically significant mitral regurgitation or hemolysis. Diagnosis is generally performed using 2-dimensional transthoracic echocardiography and TEE. Recently, an RT 3D TEE probe has been developed to produce high-quality real-time images.

Methods: We used RT 3D TEE to evaluate mitral regurgitation after mitral valve repair or replacement as a result of mitral ring dehiscence. We studied the additional information and diagnostic utility provided by RT 3D TEE.

Results: Eighteen patients were studied (8 patients after repair and 10 after replacement). Real-time 3D TEE allowed accurate evaluation of the pathology, including definition of the type of ring or prosthesis used; description of the site, size, shape, and area of the dehisced segment; and clear definition of the origin of the mitral regurgitation.

Conclusions: In mitral valve dehiscence, RT 3D TEE provides additional information about the exact anatomic characteristics of the dehiscence that can be used to help in planning the most appropriate corrective intervention.

Key Words: 3-dimensional echocardiography • transesophageal echocardiography • mitral valve

Abbreviations and Acronyms   2D = 2-dimensional   3D = 3-dimensional   MR = mitral regurgitation   RT = real-time   TEE = transesophageal echocardiography   TTE = transthoracic echocardiography

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J. Am. Coll. Cardiol. 2009 53: A28. [Full Text] [PDF]