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
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Figure 1 Dehisced Colvin-Galloway Ring, 2D Imaging
(A) A 2-dimensional (2D) transesophageal echocardiography (TEE) image showing a dehiscence of the posterior aspect of the mitral annuloplasty ring. The exact ring type cannot be delineated, and the correct assessment of the dehiscence characteristics cannot be depicted. (B) A 2D TEE color Doppler image showing that the mitral regurgitation is para-ring (outside the annuloplasty ring but within the original mitral valve annulus).
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Figure 2 Dehisced Carpentier-Edwards Ring, Real-Time 3-Dimensional Transesophageal Echocardiography
(A) En face view from the left atrium showing a dehisced Carpentier-Edwards ring. The typical characteristics of this ring can clearly be seen: a closed ring with a straightened superior segment (*). (B) En face view from the left ventricular perspective. (C) Cropped image obtained from the full-volume image, clearly showing the mitral ring in place and the dehisced portion. (D) Full-volume color Doppler image showing 2 origins of the mitral regurgitation: para-ring mitral regurgitation through a dehisced segment and transvalvular mitral regurgitation from malcoaptation of the valve leaflets.
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Figure 3 Dehisced Mitral Prostheses
(A) En face view from the left atrium. A bioprosthesis ring is seen, as well as the dehisced portion at the lateral aspect. (B) En face view from the left ventricle; the bioprosthesis struts are noted. (C) Diastolic frame of a St. Jude mechanical prosthesis, seen from the left atrial perspective. The paravalvular dehisced portion can be seen. (D) Using full-volume color Doppler acquisition, the mitral regurgitation can be clearly seen originating at the dehisced portion.
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Figure 4 Percutaneous Closure of Dehisced MTP
(A) Dehisced mitral tissue prosthesis (MTP) as seen from the left atrial perspective. (B) Catheter placed through the dehisced portion of the prosthetic valve, seen from the left atrium. Corresponding 2-dimensional color Doppler image showing significant paravalvular mitral regurgitation. (C) Successful placement of an Amplatzer PDA occluder (seen from the left atrial perspective) and significant reduction in the mitral regurgitation (MR).
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