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Role of modern 3D echocardiography in valvular heart disease.

Shiota T - Korean J. Intern. Med. (2014)

Bottom Line: Moreover, this method has become indispensable for nonsurgical mitral procedures such as edge to edge mitral repair and transcatheter closure of paravaluvular leaks.In addition, color Doppler 3D echo has been valuable to identify the location of the regurgitant orifice and the severity of the mitral regurgitation.However, the necessity of 3D echo is recognized for certain situations even for these valves, such as for evaluating the aortic annulus for transcatheter aortic valve implantation.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Heart Institute, Cedars-Sinai Medical Center and University of California, Los Angeles, Los Angeles, CA, USA.

ABSTRACT
Three-dimensional (3D) echocardiography has been conceived as one of the most promising methods for the diagnosis of valvular heart disease, and recently has become an integral clinical tool thanks to the development of high quality real-time transesophageal echocardiography (TEE). In particular, for mitral valve diseases, this new approach has proven to be the most unique, powerful, and convincing method for understanding the complicated anatomy of the mitral valve and its dynamism. The method has been useful for surgical management, including robotic mitral valve repair. Moreover, this method has become indispensable for nonsurgical mitral procedures such as edge to edge mitral repair and transcatheter closure of paravaluvular leaks. In addition, color Doppler 3D echo has been valuable to identify the location of the regurgitant orifice and the severity of the mitral regurgitation. For aortic and tricuspid valve diseases, this method may not be quite as valuable as for the mitral valve. However, the necessity of 3D echo is recognized for certain situations even for these valves, such as for evaluating the aortic annulus for transcatheter aortic valve implantation. It is now clear that this method, especially with the continued development of real-time 3D TEE technology, will enhance the diagnosis and management of patients with these valvular heart diseases.

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Normal mitral valve imaged by 2-dimensional (D) echo (A, a long axis view in diastole; B, in systole) and real-time 3D transesophageal echocardiography (C, a view from the left atrium in systole; D, in eerily diastole; E, in late diastole). Arrows indicate each leaflet: lateral P1, middle P2, and medial P3. Ao, aorta; LA, left atrium; LV, left ventricle.
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Figure 1: Normal mitral valve imaged by 2-dimensional (D) echo (A, a long axis view in diastole; B, in systole) and real-time 3D transesophageal echocardiography (C, a view from the left atrium in systole; D, in eerily diastole; E, in late diastole). Arrows indicate each leaflet: lateral P1, middle P2, and medial P3. Ao, aorta; LA, left atrium; LV, left ventricle.

Mentions: The use of TEE has also been repeatedly reported to evaluate MV anatomy in patients with MR [1,2,5,11]. However, 3D TEE was not clinically accepted until user-friendly real-time 3D TEE was introduced circa 2007. In 2008, Sugeng et al. [11] reported clinical use of real-time 3D TEE in 211 patients. Excellent visualization of the MV (85% to 91% for all scallops of both MV leaflets, the interatrial septum 84%, left atrial appendage 86%, and left ventricle 77%) was observed. This real-time 3D TEE yields high-quality images of the MV (Fig. 1). Since these initial publications, many reports have described the use of real-time 3D TEE for imaging MV pathology [14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39]. For example, in 2013, we published a study on the superiority of real-time 3D TEE over 2D TEE for measuring the gap and width of a MV prolapse and flail [22]. As seen in this paper and many others, real-time 3D TEE provides a better overall perspective of the MV than 2D TEE, including the shape of the prolapse and the exact size and location of the MV, with the use of the so-called surgical view (Fig. 2). This specific view facilitates communication between echocardiologists and surgeons and interventionists.


Role of modern 3D echocardiography in valvular heart disease.

Shiota T - Korean J. Intern. Med. (2014)

Normal mitral valve imaged by 2-dimensional (D) echo (A, a long axis view in diastole; B, in systole) and real-time 3D transesophageal echocardiography (C, a view from the left atrium in systole; D, in eerily diastole; E, in late diastole). Arrows indicate each leaflet: lateral P1, middle P2, and medial P3. Ao, aorta; LA, left atrium; LV, left ventricle.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4219957&req=5

Figure 1: Normal mitral valve imaged by 2-dimensional (D) echo (A, a long axis view in diastole; B, in systole) and real-time 3D transesophageal echocardiography (C, a view from the left atrium in systole; D, in eerily diastole; E, in late diastole). Arrows indicate each leaflet: lateral P1, middle P2, and medial P3. Ao, aorta; LA, left atrium; LV, left ventricle.
Mentions: The use of TEE has also been repeatedly reported to evaluate MV anatomy in patients with MR [1,2,5,11]. However, 3D TEE was not clinically accepted until user-friendly real-time 3D TEE was introduced circa 2007. In 2008, Sugeng et al. [11] reported clinical use of real-time 3D TEE in 211 patients. Excellent visualization of the MV (85% to 91% for all scallops of both MV leaflets, the interatrial septum 84%, left atrial appendage 86%, and left ventricle 77%) was observed. This real-time 3D TEE yields high-quality images of the MV (Fig. 1). Since these initial publications, many reports have described the use of real-time 3D TEE for imaging MV pathology [14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39]. For example, in 2013, we published a study on the superiority of real-time 3D TEE over 2D TEE for measuring the gap and width of a MV prolapse and flail [22]. As seen in this paper and many others, real-time 3D TEE provides a better overall perspective of the MV than 2D TEE, including the shape of the prolapse and the exact size and location of the MV, with the use of the so-called surgical view (Fig. 2). This specific view facilitates communication between echocardiologists and surgeons and interventionists.

Bottom Line: Moreover, this method has become indispensable for nonsurgical mitral procedures such as edge to edge mitral repair and transcatheter closure of paravaluvular leaks.In addition, color Doppler 3D echo has been valuable to identify the location of the regurgitant orifice and the severity of the mitral regurgitation.However, the necessity of 3D echo is recognized for certain situations even for these valves, such as for evaluating the aortic annulus for transcatheter aortic valve implantation.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Heart Institute, Cedars-Sinai Medical Center and University of California, Los Angeles, Los Angeles, CA, USA.

ABSTRACT
Three-dimensional (3D) echocardiography has been conceived as one of the most promising methods for the diagnosis of valvular heart disease, and recently has become an integral clinical tool thanks to the development of high quality real-time transesophageal echocardiography (TEE). In particular, for mitral valve diseases, this new approach has proven to be the most unique, powerful, and convincing method for understanding the complicated anatomy of the mitral valve and its dynamism. The method has been useful for surgical management, including robotic mitral valve repair. Moreover, this method has become indispensable for nonsurgical mitral procedures such as edge to edge mitral repair and transcatheter closure of paravaluvular leaks. In addition, color Doppler 3D echo has been valuable to identify the location of the regurgitant orifice and the severity of the mitral regurgitation. For aortic and tricuspid valve diseases, this method may not be quite as valuable as for the mitral valve. However, the necessity of 3D echo is recognized for certain situations even for these valves, such as for evaluating the aortic annulus for transcatheter aortic valve implantation. It is now clear that this method, especially with the continued development of real-time 3D TEE technology, will enhance the diagnosis and management of patients with these valvular heart diseases.

Show MeSH
Related in: MedlinePlus