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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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Three-dimensional transesophageal echocardiography images of a stenotic mitral valve (A) from the left atrium and (B) from the left ventricle. Arrows indicate severe calcifications.
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Figure 7: Three-dimensional transesophageal echocardiography images of a stenotic mitral valve (A) from the left atrium and (B) from the left ventricle. Arrows indicate severe calcifications.

Mentions: Mitral stenosis (MS) is usually caused by rheumatic MV disease. Fusion of the commissure is the major cause of the stenosis. Conventional 2D echocardiography has been widely used to determine the smallest valve area. However, 2D echocardiography can only minimally visualize the entire MV and the subvalvular apparatus, resulting in erroneous measurement of the smallest valve area. Three-dimensional echocardiography has been reported to be superior to conventional 2D echocardiography for determining the smallest area and visualizing morphological abnormalities [6,29,32,69,70,71,72,73,74,75,76,77,78]. In an early study, 3D echocardiography provided accurate and highly reproducible measurements of the mitral valve area (MVA) and was easily performed via an apical approach [70]. In another study, a real-time 3D echocardiographic system was used for MV planimetry [72]. This was reportedly more accurate than the Gorlin method for measurement of the valve area. The authors concluded that 3D echo planimetry may be a better reference method than the Gorlin method in terms of assessing the severity of rheumatic MS [72]. The recently introduced real-time 3D TEE yields striking images of MS in patients (Fig. 7) [79]. Not only the stenosis but also the shape, location, and anatomical abnormalities of the MV leaflets, such as heavy calcification, are visualized intuitively. In a clinical study of 43 patients with rheumatic MV stenosis, 3D TEE allowed excellent assessment of commissural fusion and MVA planimetry (Fig. 7) [75]. Also, a recent Korean study showed a tendency of overestimation of MVA by 2D planimetry and concluded that 3D TEE should be considered for accurate MVA assessment, especially in patients with a large left atrium and large angle between the lines of the true MV tip and the echo beam-to-the tip [38].


Role of modern 3D echocardiography in valvular heart disease.

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

Three-dimensional transesophageal echocardiography images of a stenotic mitral valve (A) from the left atrium and (B) from the left ventricle. Arrows indicate severe calcifications.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 7: Three-dimensional transesophageal echocardiography images of a stenotic mitral valve (A) from the left atrium and (B) from the left ventricle. Arrows indicate severe calcifications.
Mentions: Mitral stenosis (MS) is usually caused by rheumatic MV disease. Fusion of the commissure is the major cause of the stenosis. Conventional 2D echocardiography has been widely used to determine the smallest valve area. However, 2D echocardiography can only minimally visualize the entire MV and the subvalvular apparatus, resulting in erroneous measurement of the smallest valve area. Three-dimensional echocardiography has been reported to be superior to conventional 2D echocardiography for determining the smallest area and visualizing morphological abnormalities [6,29,32,69,70,71,72,73,74,75,76,77,78]. In an early study, 3D echocardiography provided accurate and highly reproducible measurements of the mitral valve area (MVA) and was easily performed via an apical approach [70]. In another study, a real-time 3D echocardiographic system was used for MV planimetry [72]. This was reportedly more accurate than the Gorlin method for measurement of the valve area. The authors concluded that 3D echo planimetry may be a better reference method than the Gorlin method in terms of assessing the severity of rheumatic MS [72]. The recently introduced real-time 3D TEE yields striking images of MS in patients (Fig. 7) [79]. Not only the stenosis but also the shape, location, and anatomical abnormalities of the MV leaflets, such as heavy calcification, are visualized intuitively. In a clinical study of 43 patients with rheumatic MV stenosis, 3D TEE allowed excellent assessment of commissural fusion and MVA planimetry (Fig. 7) [75]. Also, a recent Korean study showed a tendency of overestimation of MVA by 2D planimetry and concluded that 3D TEE should be considered for accurate MVA assessment, especially in patients with a large left atrium and large angle between the lines of the true MV tip and the echo beam-to-the tip [38].

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