Limits...
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

Intraoperative two-dimensional transesophageal echocardiography. Midesophageal (ME) long-axis (LAX) and commissural views with color Doppler showing severe regurgitation between the mid-part of anterior and posterior mitral leaflets (A2 and P2 scallops). The free margin of the AML tip appears intact in the ME LAX view. Central regurgitant flow arising from the mid scallop gap, A2 or P2, is noted in the ME commissural view. However, it was difficult to make a definite diagnosis regarding which part was responsible for the concurrent coaptation defect of the mitral valve producing mitral regurgitation using these views. LA: left atrium, LV: left ventricle, Ao: aorta, AML: anterior mitral leaflet, PML: posterior mitral leaflet. P1: anteriolateral scallop of PML, P2: middle scallop of PML, P3: posteromedial scallop of PML, and A2: middle part of AML (Video images are available on-line, video link 3 and 4).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC3927007&req=5

Figure 2: Intraoperative two-dimensional transesophageal echocardiography. Midesophageal (ME) long-axis (LAX) and commissural views with color Doppler showing severe regurgitation between the mid-part of anterior and posterior mitral leaflets (A2 and P2 scallops). The free margin of the AML tip appears intact in the ME LAX view. Central regurgitant flow arising from the mid scallop gap, A2 or P2, is noted in the ME commissural view. However, it was difficult to make a definite diagnosis regarding which part was responsible for the concurrent coaptation defect of the mitral valve producing mitral regurgitation using these views. LA: left atrium, LV: left ventricle, Ao: aorta, AML: anterior mitral leaflet, PML: posterior mitral leaflet. P1: anteriolateral scallop of PML, P2: middle scallop of PML, P3: posteromedial scallop of PML, and A2: middle part of AML (Video images are available on-line, video link 3 and 4).

Mentions: After induction of anesthesia, a 3D-TEE probe (X7-2t transducer; Philips Healthcare, Andover, MA, USA) was placed and connected to a TEE console (iE33™, Philips Healthcare, Andover, MA, USA) and intraoperative 2D and 3D TEE examinations were performed. The 2D TEE images in the midesophageal commissural and long axis views also supported the preoperative diagnosis regarding a severe MR and systolic coaptation defect between the AML and posterior mitral leaflet (PML) (Fig. 2, Video 3 and 4). However, intraoperative real time 3D TEE provided more detailed spatial information on the MR pathology, which was entirely different from that suggested by the preoperative TTE; the "en face view" in the left atrial perspective showed a cleft in the middle of the PML, a ruptured chordae attached to the P3 scallop moving toward the left atrium during systole, and fusion of both ends of the MV commissures producing mild MS (Fig. 3, Video 5). Interestingly, the defect or cleft in the AML, which had been suggested, was not observed.


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)

Intraoperative two-dimensional transesophageal echocardiography. Midesophageal (ME) long-axis (LAX) and commissural views with color Doppler showing severe regurgitation between the mid-part of anterior and posterior mitral leaflets (A2 and P2 scallops). The free margin of the AML tip appears intact in the ME LAX view. Central regurgitant flow arising from the mid scallop gap, A2 or P2, is noted in the ME commissural view. However, it was difficult to make a definite diagnosis regarding which part was responsible for the concurrent coaptation defect of the mitral valve producing mitral regurgitation using these views. LA: left atrium, LV: left ventricle, Ao: aorta, AML: anterior mitral leaflet, PML: posterior mitral leaflet. P1: anteriolateral scallop of PML, P2: middle scallop of PML, P3: posteromedial scallop of PML, and A2: middle part of AML (Video images are available on-line, video link 3 and 4).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: Intraoperative two-dimensional transesophageal echocardiography. Midesophageal (ME) long-axis (LAX) and commissural views with color Doppler showing severe regurgitation between the mid-part of anterior and posterior mitral leaflets (A2 and P2 scallops). The free margin of the AML tip appears intact in the ME LAX view. Central regurgitant flow arising from the mid scallop gap, A2 or P2, is noted in the ME commissural view. However, it was difficult to make a definite diagnosis regarding which part was responsible for the concurrent coaptation defect of the mitral valve producing mitral regurgitation using these views. LA: left atrium, LV: left ventricle, Ao: aorta, AML: anterior mitral leaflet, PML: posterior mitral leaflet. P1: anteriolateral scallop of PML, P2: middle scallop of PML, P3: posteromedial scallop of PML, and A2: middle part of AML (Video images are available on-line, video link 3 and 4).
Mentions: After induction of anesthesia, a 3D-TEE probe (X7-2t transducer; Philips Healthcare, Andover, MA, USA) was placed and connected to a TEE console (iE33™, Philips Healthcare, Andover, MA, USA) and intraoperative 2D and 3D TEE examinations were performed. The 2D TEE images in the midesophageal commissural and long axis views also supported the preoperative diagnosis regarding a severe MR and systolic coaptation defect between the AML and posterior mitral leaflet (PML) (Fig. 2, Video 3 and 4). However, intraoperative real time 3D TEE provided more detailed spatial information on the MR pathology, which was entirely different from that suggested by the preoperative TTE; the "en face view" in the left atrial perspective showed a cleft in the middle of the PML, a ruptured chordae attached to the P3 scallop moving toward the left atrium during systole, and fusion of both ends of the MV commissures producing mild MS (Fig. 3, Video 5). Interestingly, the defect or cleft in the AML, which had been suggested, was not observed.

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