Surgical echocardiography of heart valves: a primer for the cardiovascular surgeon

Echocardiography is the primary noninvasive tool for evaluating the structure and function of cardiac valves and has become an essential diagnostic test in pre-, intra-, and postoperative management. Standard echocardiogram reports include several measurements and findings important to most cardiovascular and cardiothoracic surgeons. These measurements are derived from multiple standard imaging techniques, such as M-mode, 2-dimensional (2D), spectral Doppler and color Doppler which are employed in transthoracic (TTE) and transesophageal (TEE) echocardiography. As an ensemble, these techniques provide a comprehensive assessment of primary valve pathology and its secondary effects. In this review, we describe the use of these techniques in the imaging of the mitral, aortic, tricuspid and pulmonic valves. In addition, we highlight the clinical uses of real-time 3-dimensional echocardiography (RT3DE) to evaluate valvular pathology, and the emerging use of a new matrix array 3D TEE probe.