[Three-dimensional reconstruction of heart valves]

The reconstruction of three-dimensional data sets from two-dimensional echocardiographic images offers several fundamental advantages: 1. more complete data than present in the few standard 2D-view; 2. off-line generation of any desired plane, cut, or perspective after the data set has been acquired; 3. access to quantitative parameters like surface areas (e.g., of valve leaflets or portions of leaflets), volumes, and others, without geometric assumptions. The mitral valve has been the focus of several studies using various techniques of reconstruction of transthoracic or transesophageal images. These studies have shown the mitral annulus to be a non-planar, "saddle-shaped" structure, with an average distance of highest to lowest points of 14 mm in normals. This recognition of mitral annular non-planarity has led to a more stringent echocardiographic definition of mitral valve prolapse. Further studies have shown systolic shrinkage of mitral annular area by about 30% and systolic apico-basal translation of the annulus by approximately 1 cm in normals. In patients with dilated cardiomyopathy, the annulus is flattened, and both cyclic change in annular area and apico-basal translation are significantly reduced. 3D-studies of the left ventricular outflow tract in hypertrophic obstructive cardiomyopathy allow measurement of outflow tract and leaflet surface areas and dynamic spatial visualization of systolic anterior motion of the anterior mitral leaflet. Automated techniques to reconstruct the full grey value data set from a high number of parallel or rotational transesophageal planes allow impressive visualization of normal and diseased mitral and aortic valves or valve prostheses, with special emphasis on generating "surgical" views and perspectives, which cannot be obtained by conventional tomographic imaging.(ABSTRACT TRUNCATED AT 250 WORDS)