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Usefulness of intraoperative real-time three-dimensional transesophageal echocardiography for pre-procedural evaluation of mitral valve cleft: a case report.

Jung HJ, Yu GY, Seok JH, Oh C, Kim SH, Yoon TG, Kim TY - Korean J Anesthesiol (2014)

Bottom Line: She had a history of undergoing percutaneous balloon valvuloplasty due to rheumatic mitral stenosis during a previous pregnancy.A preoperative transthoracic echocardiography suggested a tear in the mid tip of the anterior mitral leaflet.The present case shows that intraoperative RT 3D-TEE provides more precise and reliable spatial information of MV for MVRep and facilitates critical surgical decision-making.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology and Pain Medicine, Uijongbu St. Mary's Hospital, The Catholic University of Korea, Uijeongbu, Korea.

ABSTRACT
A precise pre-procedural evaluation of mitral valve (MV) pathology is essential for planning the surgical strategy for severe mitral regurgitation (MR) and preparing for the intraoperative procedure. In the present case, a 38-year-old woman was scheduled to undergo MV replacement due to severe MR. She had a history of undergoing percutaneous balloon valvuloplasty due to rheumatic mitral stenosis during a previous pregnancy. A preoperative transthoracic echocardiography suggested a tear in the mid tip of the anterior mitral leaflet. However, the "en face" view of the MV in the left atrial perspective using intraoperative real time three-dimensional transesophageal echocardiography (RT 3D-TEE) provided a different diagnosis: a torn cleft in the P2-scallop of the posterior mitral leaflet (PML) with rupture of the chordae. Thus, surgical planning was changed intraoperatively to MV repair (MVRep) consisting of patch closure of the PML, commissurotomy, and lifting annuloplasty. The present case shows that intraoperative RT 3D-TEE provides more precise and reliable spatial information of MV for MVRep and facilitates critical surgical decision-making.

No MeSH data available.


Related in: MedlinePlus

Preoperative two-dimensional (2D) transthoracic echocardiography. Two-chamber views with 2D and color Doppler showing severe mitral regurgitation due to a coaptation defect between the anterior and posterior mitral leaflets. The regurgitant flow arising from the tip of the AML in these views (arrow) suggests a defect in the free margin of the AML tip. LA: left atrium, LV: left ventricle, AML: anterior mitral leaflet (Video images are available on-line, video link 1 and 2).
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Figure 1: Preoperative two-dimensional (2D) transthoracic echocardiography. Two-chamber views with 2D and color Doppler showing severe mitral regurgitation due to a coaptation defect between the anterior and posterior mitral leaflets. The regurgitant flow arising from the tip of the AML in these views (arrow) suggests a defect in the free margin of the AML tip. LA: left atrium, LV: left ventricle, AML: anterior mitral leaflet (Video images are available on-line, video link 1 and 2).

Mentions: A 38-year-old woman planned to undergo open heart surgery to surgically correct a known severe MR. She had a history of undergoing percutaneous balloon valvuloplasty due to rheumatic mitral stenosis (MS) during a previous pregnancy 10 years before. At the preoperative evaluation employing 2D TTE, a tearing of the tip of a mid part of the thickened anterior mitral valve leaflet (AML) was suggested to be the main reason for a coaptation defect producing severe MR; two-chambered views using color Doppler showed a severe central MR jet projecting into an enlarged left atrium (Fig. 1, Video 1 and 2). MVR to install a bioprosthetic valve was planned preoperatively considering the technical difficulties and worse outcome of a patch repair of a large defect on the free margin of the AML.


Usefulness of intraoperative real-time three-dimensional transesophageal echocardiography for pre-procedural evaluation of mitral valve cleft: a case report.

Jung HJ, Yu GY, Seok JH, Oh C, Kim SH, Yoon TG, Kim TY - Korean J Anesthesiol (2014)

Preoperative two-dimensional (2D) transthoracic echocardiography. Two-chamber views with 2D and color Doppler showing severe mitral regurgitation due to a coaptation defect between the anterior and posterior mitral leaflets. The regurgitant flow arising from the tip of the AML in these views (arrow) suggests a defect in the free margin of the AML tip. LA: left atrium, LV: left ventricle, AML: anterior mitral leaflet (Video images are available on-line, video link 1 and 2).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3927007&req=5

Figure 1: Preoperative two-dimensional (2D) transthoracic echocardiography. Two-chamber views with 2D and color Doppler showing severe mitral regurgitation due to a coaptation defect between the anterior and posterior mitral leaflets. The regurgitant flow arising from the tip of the AML in these views (arrow) suggests a defect in the free margin of the AML tip. LA: left atrium, LV: left ventricle, AML: anterior mitral leaflet (Video images are available on-line, video link 1 and 2).
Mentions: A 38-year-old woman planned to undergo open heart surgery to surgically correct a known severe MR. She had a history of undergoing percutaneous balloon valvuloplasty due to rheumatic mitral stenosis (MS) during a previous pregnancy 10 years before. At the preoperative evaluation employing 2D TTE, a tearing of the tip of a mid part of the thickened anterior mitral valve leaflet (AML) was suggested to be the main reason for a coaptation defect producing severe MR; two-chambered views using color Doppler showed a severe central MR jet projecting into an enlarged left atrium (Fig. 1, Video 1 and 2). MVR to install a bioprosthetic valve was planned preoperatively considering the technical difficulties and worse outcome of a patch repair of a large defect on the free margin of the AML.

Bottom Line: She had a history of undergoing percutaneous balloon valvuloplasty due to rheumatic mitral stenosis during a previous pregnancy.A preoperative transthoracic echocardiography suggested a tear in the mid tip of the anterior mitral leaflet.The present case shows that intraoperative RT 3D-TEE provides more precise and reliable spatial information of MV for MVRep and facilitates critical surgical decision-making.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology and Pain Medicine, Uijongbu St. Mary's Hospital, The Catholic University of Korea, Uijeongbu, Korea.

ABSTRACT
A precise pre-procedural evaluation of mitral valve (MV) pathology is essential for planning the surgical strategy for severe mitral regurgitation (MR) and preparing for the intraoperative procedure. In the present case, a 38-year-old woman was scheduled to undergo MV replacement due to severe MR. She had a history of undergoing percutaneous balloon valvuloplasty due to rheumatic mitral stenosis during a previous pregnancy. A preoperative transthoracic echocardiography suggested a tear in the mid tip of the anterior mitral leaflet. However, the "en face" view of the MV in the left atrial perspective using intraoperative real time three-dimensional transesophageal echocardiography (RT 3D-TEE) provided a different diagnosis: a torn cleft in the P2-scallop of the posterior mitral leaflet (PML) with rupture of the chordae. Thus, surgical planning was changed intraoperatively to MV repair (MVRep) consisting of patch closure of the PML, commissurotomy, and lifting annuloplasty. The present case shows that intraoperative RT 3D-TEE provides more precise and reliable spatial information of MV for MVRep and facilitates critical surgical decision-making.

No MeSH data available.


Related in: MedlinePlus