Diagnostic Accuracy of Transillumination in Mitral Valve Prolapse: Side-by-Side Comparison of Standard Transthoracic Three-Dimensional Echocardiography against Surgical Findings

Abstract

In patients with mitral valve prolapse (MVP) eligible for surgery, three-dimensional echocardiographic (3DE) imaging is routinely used for preoperative assessment. 1 Baumgartner H. Falk V. Bax J.J. De Bonis M. Hamm C. Holm P.J. et al. 2017 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J. 2017; 38: 2739-2791 Crossref PubMed Scopus (2) Google Scholar ,2 Nishimura R.A. Otto C.M. Bonow R.O. Carabello B.A. Erwin J.P. Fleisher L.A. et al. 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2017; 70: 252-289 Crossref PubMed Scopus (1731) Google Scholar Despite the worldwide use of transesophageal echocardiography in this context, transthoracic echocardiographic (TTE) imaging allows accurate noninvasive evaluation of mitral valve (MV) anatomy and pathology. 3 Gripari P. Mapelli M. Bellacosa I. Piazzese C. Milo M. Fusini L. et al. Transthoracic echocardiography in patients undergoing mitral valve repair: comparison of new transthoracic 3D techniques to 2D transoesophageal echocardiography in the localization of mitral valve prolapse. Int J Cardiovasc Imaging. 2018; 34: 1099-1107 Crossref PubMed Scopus (10) Google Scholar , 4 Tamborini G. Muratori M. Maltagliati A. Galli C.A. Naliato M. Zanobini M. et al. Pre-operative transthoracic real-time three-dimensional echocardiography in patients undergoing mitral valve repair: accuracy in cases with simple vs. complex prolapse lesions. Eur J Echocardiogr. 2010; 11: 778-785 Crossref PubMed Scopus (43) Google Scholar , 5 Pepi M. Tamborini G. Maltagliati A. Galli C.A. Sisillo E. Salvi L. et al. Head-to-head comparison of two- and three-dimensional transthoracic and transesophageal echocardiography in the localization of mitral valve prolapse. J Am Coll Cardiol. 2006; 48: 2524-2530 Crossref PubMed Scopus (196) Google Scholar Transillumination (TI) is a new three-dimensional tool that improves the visualization of cardiac structures due to shadow effects achieved by the use of a virtual light source. 6 Genovese D. Addetia K. Kebed K. Kruse E. Yamat M. Narang A. et al. First clinical experience with 3-dimensional echocardiographic transillumination rendering. JACC Cardiovasc Imaging. 2019; 12: 1868-1871 Crossref PubMed Scopus (20) Google Scholar We aimed to compare the diagnostic accuracy of TTE TI side by side with standard 3DE (s3DE) display in patients undergoing surgery for MVP. Surgical valve inspection was used as a reference standard, even though surgery allows only static MV assessment. 3 Gripari P. Mapelli M. Bellacosa I. Piazzese C. Milo M. Fusini L. et al. Transthoracic echocardiography in patients undergoing mitral valve repair: comparison of new transthoracic 3D techniques to 2D transoesophageal echocardiography in the localization of mitral valve prolapse. Int J Cardiovasc Imaging. 2018; 34: 1099-1107 Crossref PubMed Scopus (10) Google Scholar , 4 Tamborini G. Muratori M. Maltagliati A. Galli C.A. Naliato M. Zanobini M. et al. Pre-operative transthoracic real-time three-dimensional echocardiography in patients undergoing mitral valve repair: accuracy in cases with simple vs. complex prolapse lesions. Eur J Echocardiogr. 2010; 11: 778-785 Crossref PubMed Scopus (43) Google Scholar , 5 Pepi M. Tamborini G. Maltagliati A. Galli C.A. Sisillo E. Salvi L. et al. Head-to-head comparison of two- and three-dimensional transthoracic and transesophageal echocardiography in the localization of mitral valve prolapse. J Am Coll Cardiol. 2006; 48: 2524-2530 Crossref PubMed Scopus (196) Google Scholar