ON THE COVER Two-dimensional (2D) transesophageal echocardiography identifies the mechanism of mitral regurgitation, demonstrates the approximate location of the lesion, and estimates the severity of mitral regurgitation. With multiple planes in 2D, we are able to mentally reconstruct a 3-dimensional (3D) image of the mitral valve to demonstrate the mitral valve abnormality. In the past, reconstructions of the mitral valve were possible but were limited by rotational artifacts, lengthy acquisition, and complicated off-line computer processing. Recent developments in probe and ultrasound technology have resulted in a 3D matrix transesophageal echocardiography (MTEE) probe capable of real-time 3D imaging. As seen in this figure, this technique was able to exactly locate in real time the flail posterior leaflet as visualized from a left atrial orientation (bottom, left). Images are depicted in a similar manner to that of a surgeon's perspective. Once a 3D volume dataset is obtained, quantitative software can be used to measure the mitral valve annulus, commissural line, anterior and posterior leaflets, papillary muscles, and a multitude of other parameters (bottom, right). The abnormality shaded in yellow designates that the P3 segment is above the height of the remaining mitral leaflets. On intra-operative assessment, the P3 scallop as seen by the surgeon (top, right) confirmed the 3D MTEE findings. Images provided by Lissa Sugeng, MD, MPH,* Stanton K. Sherman, 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,* Roberto M. Lang, MD,* from the *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; and ‡Philips Medical Systems, Andover, Massachusetts. Please note: Roberto M. Lang, MD, is on the Speaker's Bureau for Philips Medical Systems.

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