629 Validation of real-time 3D echocardiography study protocol in identification of anatomic mitral regurgitant defect in patients with prolapse or flail

Abstract

Background: In patients with mitral regurgitation (MR), valve repair is a major incentive to early surgery and is decided on the basis of the mechanisms and anatomic mitral lesions. These lesions can be easily studied with transesophageal echocardiography (TEE). A study protocol of real-time 3D echocardiography (RT3D) for the identifications of the valve defect is not well validated. Objectives: This study was performed to validate a protocol of RT3D for assessment mitral valve for identification of anatomic valve defect due to prolapse or flail using TEE as gold standard. Methods: One hundred and nineteen consecutive patients with moderate to severe MR (mean age 64±3.4) were studied with RT3D and TEE to identify the valve defects causing MR and the results were evaluated in blind manner. RT3D study protocol was performed as follows: data were acquired in a zoom mode and in a full-volume mode from apical window. Then, using 3D Qlab software (version 2.0, Philips), a volume rendered en-face view of the mitral valve from the left atrium was reconstructed and guided by this view, a series of longitudinal cutplanes were reconstructed to visualise A1P1, A2-P2 and A3-P3. Segmental analysis of the valve was evaluated according to American Society of Echocardiography guidelines. Results: Among 119 patients, 66 had prolapse or flail by TEE. The accuracy of RT3D for prolapse lesion was 97% (p=0.0001), with a sensitivity and specificity of 95% and 96% , whereas for flail lesion the accuracy was 95% (p=0.0001) with a sensitivity and specificity of 91% and 97%. The diagnostic accuracy for the individual scallops is reported in Table 1. Conclusions: RT3D protocol using rendered en-face view and a series of longitudinal cutplanes is highly accurate in the identification of anatomic valve defect and its location, particularly showing high specificity values.