The Usefulness of Intraoperative Three-Dimensional Transesophageal Echocardiography (3D TEE) Analysis for Evaluation of Mitral Valve Prolapse

Abstract

Three-dimensional (3D) imaging provides a more comprehensive view of annular structure and allows accurate reconstructions of mitral valve anatomy to evaluate the feasibility of intraoperative 3D TEE in patients with mitral valve prolapse (MVP). A 37-year-old man was scheduled to undergo mitral valve plasty due to mitral regurgitation. Pre-operative transthoracic echocardiography showed moderate mitral valve regurgitation with a portion of a posterior leaflet(P2). 2D TEE examination was performed after tracheal intubation, by which 3D TEE mitral valve formation was constructed using 4D surgical view software (Tomtec TM). The location of the prolapse of the mitral valve was assessed with six valve elements (A1, A2, A3, P1, P2, P3: 6 points) and the data were examined. 2D TEE findings of MVP localization were in P1, P2. 3D TEE findings were A3, P2 prolapse at blood pressure 80/52 mmHg. And A3, P2, P3 prolapse at blood pressure 100/72 mmHg. Intraoperative 3D TEE evaluation of MVP was possible before initiation of the surgical procedure and feasible. Accurate anatomical finding of MVP is sometimes difficult to understand with use of 2D TEE findings and even with surgical finding after cardiac arrest. 3D data should be of value to the surgeon when performing mitral valve repair.