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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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Real-time three-dimensional transesophageal images, showing the difference in the shape of left ventricular outflow tract (LVOT) between discrete subaortic stenosis (DSS) and hypertrophic obstructive cardiomyopathy. (A) The DSS images show the almost oval or flat shape of the LVOT (Ad) and subaortic membrane with small fenestration at left upper site of membrane (Aa and Ab, arrow). The thin membranous structure changes its angle to decrease the LVOT area along the blood stream (Ac and Ad, arrows). (B) In hypertrophic obstructive cardiomyopathy, the shape of the LVOT is a V formation or two separate open spaces due to systolic anterior motion of mitral anterior leaflet (Bc and Bd, arrows).
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Figure 11: Real-time three-dimensional transesophageal images, showing the difference in the shape of left ventricular outflow tract (LVOT) between discrete subaortic stenosis (DSS) and hypertrophic obstructive cardiomyopathy. (A) The DSS images show the almost oval or flat shape of the LVOT (Ad) and subaortic membrane with small fenestration at left upper site of membrane (Aa and Ab, arrow). The thin membranous structure changes its angle to decrease the LVOT area along the blood stream (Ac and Ad, arrows). (B) In hypertrophic obstructive cardiomyopathy, the shape of the LVOT is a V formation or two separate open spaces due to systolic anterior motion of mitral anterior leaflet (Bc and Bd, arrows).

Mentions: Regarding the subaortic membrane, multiplane analysis of 3D datasets is reportedly a sensitive and accurate method for delineation of morphological details of discrete sub-AS, adding to information gained from 2D echocardiography [118]. Recently, we reported the value of real-time 3D TEE for evaluating dynamic changes in the LVOT in both the subaortic membrane and in obstructive hypertrophic cardiomyopathy (Fig. 11) [119].


Role of modern 3D echocardiography in valvular heart disease.

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

Real-time three-dimensional transesophageal images, showing the difference in the shape of left ventricular outflow tract (LVOT) between discrete subaortic stenosis (DSS) and hypertrophic obstructive cardiomyopathy. (A) The DSS images show the almost oval or flat shape of the LVOT (Ad) and subaortic membrane with small fenestration at left upper site of membrane (Aa and Ab, arrow). The thin membranous structure changes its angle to decrease the LVOT area along the blood stream (Ac and Ad, arrows). (B) In hypertrophic obstructive cardiomyopathy, the shape of the LVOT is a V formation or two separate open spaces due to systolic anterior motion of mitral anterior leaflet (Bc and Bd, arrows).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 11: Real-time three-dimensional transesophageal images, showing the difference in the shape of left ventricular outflow tract (LVOT) between discrete subaortic stenosis (DSS) and hypertrophic obstructive cardiomyopathy. (A) The DSS images show the almost oval or flat shape of the LVOT (Ad) and subaortic membrane with small fenestration at left upper site of membrane (Aa and Ab, arrow). The thin membranous structure changes its angle to decrease the LVOT area along the blood stream (Ac and Ad, arrows). (B) In hypertrophic obstructive cardiomyopathy, the shape of the LVOT is a V formation or two separate open spaces due to systolic anterior motion of mitral anterior leaflet (Bc and Bd, arrows).
Mentions: Regarding the subaortic membrane, multiplane analysis of 3D datasets is reportedly a sensitive and accurate method for delineation of morphological details of discrete sub-AS, adding to information gained from 2D echocardiography [118]. Recently, we reported the value of real-time 3D TEE for evaluating dynamic changes in the LVOT in both the subaortic membrane and in obstructive hypertrophic cardiomyopathy (Fig. 11) [119].

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