Three-dimensional echocardiography for planning of mitral valve surgery: current applicability?

Two-dimensional transesophageal echocardiographic (2D TEE) assessment of the mitral valve requires mental integration of a limited number of 2D imaging planes. Structural display in three dimensions from any perspective may be of advantage to the surgeon for better judgment and planning.

Feasibility, accuracy, and limitations of preoperative three-dimensional transesophageal echocardiography (3D TEE) was assessed in 51 patients with mitral valve disease. The width of the anterior mitral valve was measured with either method and compared with the operative finding. Three-dimensional dynamic sequences of the reconstructed mitral valve were shown preoperatively to the surgeon and later compared with the intraoperative finding.

The quality of the 3D reconstruction was graded as good in 25 patients (49.0%), fair in 16 patients (31.4%), and poor in 10 patients (19.6%) where atrial fibrillation did not allow ECG gating. Thirty-nine patients had successful mitral valve repair and twelve patients required valve replacement. Based on intraoperative findings, sensitivity for the diagnosis of mitral valve prolapse using 2D TEE and 3D TEE was 97.7% and 92.9% (p = ns) respectively and specificity was 100% by both methods. Sensitivity for the diagnosis of rupture of chordae tendineae using 2D TEE and 3D TEE was 92.3% and 30.8% respectively (p < 0.05) and specificity was 100% by both methods.

Dynamic 3D echocardiography is feasible and can provide good insight into valvular motion and allows adequate preoperative planning when reconstruction is being considered. However dynamic 3D reconstruction is currently limited by the quality of the original 2D echo cross sectional images which can be adversely affected by minimal patient movements, breathing, or cardiac arrhythmia, thus limiting accuracy of the 3D TEE significantly compared with 2D TEE.