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.
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Figure 2 Four examples of prolapses of different scallops (arrows) of the mitral valve correctly identified by 3D TTE and 3D TEE. Each of the 4 panels shows head-to-head comparison of 3D TTE (left side) and 3D TEE (right side) techniques by imaging the valve in the surgical view (from the left atrium). (A) P1 prolapse; (B) P2 prolapse; (C) P3 prolapse; (D) A2 prolapse. AO = aorta; other abbreviations as in Figure 1.
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Figure 3 Example of a patient with a complex bileaflet mitral valve prolapse in whom 3D TTE (A) allowed a non-complete definition of the pathology, whereas 3D TEE (B and C) correctly identified the prolapse of P1, A2, and A3. (D) Shows in an oblique surgical view involvement of the anterior (A2, A3, arrows) and of the posterior (P1, dashed arrow) scallops. TV = tricuspid valve; other abbreviations as in Figures 1 and 2.
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Figure 4 Examples of chordal rupture (arrows) associated with mitral valve prolapse. (A) 3D TTE reconstruction from the apical windows. (B) Surgical view (from the left atrium) and (C) longitudinal view in a 3D TEE reconstruction of mitral valve. LA = left atrium; LV = left ventricle; other abbreviations as in Figure 1.
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p < 0.001 versus 3D TTE; 
p < 0.001 versus 2D TEE. 2D = two-dimensional; 3D = three-dimensional; TEE = transesophageal echocardiography; TTE = transthoracic echocardiography.