ECHO ROUND: THREE DIMENSIONAL TRIMMING, THE FREE ANGLE ALTERNATIVE FOR MITRAL AND AORTIC VALVE VITIUM ASSESSMENT.

Abstract

Three-dimensional (3D) Technology provides real time dynamic assessment and allows for multiplanar reconstruction (MPR) for the different cardiac structures. However, it is much more demanding regarding the Echo device specification, and operator experience in both loop acquisition, enhancement and of course interpretation. Trimming function is one of the post-acquisition software tools, which can be used in step-by-step assessment of the Mitral valve (MV) and aortic valve (AV) vitrium. It didn't overcome the required experience required for the interpretation of 3D images. But when systematically done, it makes it more objective and allows for assessment of the coaptation line along the valve leaflets, even in cases where it is impossible to assess in 2D as between non-coronary and left coronary AV cusps. The loops in this poster were acquired with the Philips Affinity 70 and the X7-2T transoesophageal matrix array transducer. The basic requirement of the 3D loop acquisition is guided by the published recommendation as it is and when possible multibeat acquisition is used.1. In MV Our examination started in Midesophageal Intercommisural View with 3D Zoom function. We rotated the acquired loop to obtain the surgical view of the MV with the Aorta at 12 O'clock (Figure 1, Step 1). At this point we rotated the aorta to be positioned at 9 O'clock. (Figure 1 Step 2). Then, using the track ball, we rotated the 3D picture 90 degrees in the vertical axis to be facing the lateral annulus of the MV (Figure 1, Step 3) . Starting from this view, using the face Trimming function (figure 1 Step 4) we have adjusted the trimming level going deeper all through the MV from lateral to medial, examining the coaptation line all through all parts of the leaflets. What also helped to delineate the leaflets was to add more gain (in controversy to what is normally done to improve the 3D Image). For orientation, we recommend rotating the 3D loop back to surgical view to localize the trimming level. Color Flow Examination normally requires a multibeat acquisition to get a reasonable frame rate. We also trimmed from lateral to medial till we could see the Regurgitation Jet. (Figure 3) For AV we started with the Midesophageral AV short axis view and using loop was acquired using the 3D zoom function (Figure 4). Using the same technique we have adjusted the trimming line to go through the coaptation line needed to be examined between Non coronary cusp (NCC) – Right coronary cusp (RCC), RCC- Left coronary cusp (LCC) and NCC-LCC . (figure 5) .In each level we used the track ball to rotate the 3D image to get an inface view where we could see the coaptation. We could also measure coaptation height, coaptation length and identify single leaflet pathology. <b>Conclusion:</b> In contrast to 2D images the Trimming function allows a free angle generation of 2D images for angles difficult or sometimes impossible to be obtained with normal 2D cutting or even biplane.