Abstract
Imaging of prosthetic devices has several technical limitations, especially in cases with acoustic shadowing or reverberation when valve dysfunction is suspected. Three-dimensional (3D) transesophageal echocardiography (3D-TEE) images provide appropriate visualization of valvular anatomy and proper quantification of valvular heart disease with superior spatial and temporal resolution compared with transthoracic echocardiography (TTE). 3D-TEE has improved visualization and assessment of complications in prosthetic valves, such as endocarditis or paravalvular regurgitation. Deep anatomic structures can be well displayed by manipulation and cropping wide-angled, full-volume datasets. Moreover, 3D-TEE images provide valvular visualization from any angle, which has been limited in 2D planar views. We can see the mitral mechanical and bioprosthetic valve rings, leaflets, and struts clearly by using 3D-TEE. Paravalvular regurgitation can also be identified. Quantification of the dehisced area using multiplanar imaging can be confirmed by the use of 3D color flow. It clearly demonstrates the location and size of mitral paravalvular leaks, describing the number of sites of dehiscence and its configuration. For the imaging of prosthetic valves, ‘3D zoom’ and ‘live’ modes are the most frequently used, giving priority to frame rate and imaging resolution. Orientating a structure from the axial direction of the beam allows new perspectives of the valvular structures on its face view (surgeon's view) and on its ventricular view. These allow us to understand the morphology and spatial relation among the intracardiac structures, resulting in diagnostic confidence and better communication among the heart team, at the time of clinical decision-making for surgery, for selecting patients for percutaneous interventions, and during the effective performance of these procedures.
