Three-dimensional Echocardiography Is Essential for Intraoperative Assessment of Mitral Regurgitation

Abstract

Since its introduction, 3-dimensional (3D) transesophageal echocardiography (TEE) has become widely adopted in operating rooms and cardiac catheterization laboratories worldwide. This is because the matrix-array 3D TEE probe allows acquisition of high-quality 3D images in real time with relatively little training. The rapid adoption of this technology has proven that this innovative imaging modality provides additional clinical information beyond that obtained from 2-dimensional (2D) TEE images. These developments have enabled medical centers to create integrated valve programs in which surgeons, interventionalists, and echocardiographers discuss cases and surgical approaches. Response by McCarthy on p 652 In particular, 3D TEE has been proven to be superior to 2D TEE in the assessment of both mitral valve anatomy and mitral regurgitation, promoting its use in the operating room (Table 1).1–3 One reason for this superiority is that 3D TEE allows the mitral valve to be displayed en face in an orientation identical to the surgeon’s view of the mitral valve intraoperatively. This surgeon’s view greatly facilitates communication with cardiac surgeons because they can easily interpret these images. View this table: Table 1. Advantages of 3D Echocardiography in the Evaluation of Mitral Regurgitation in the Operating Room Here, we argue that the widespread acceptance and use of 3D TEE are attributable to the pivotal role this modality plays in the intraoperative assessment of mitral regurgitation. We believe that 3D TEE of the mitral valve is invaluable not only because of the realistic images it provides but also because it improves: 1) lesion localization, 2) identification of the mechanisms causing mitral regurgitation, 3) quantification of the severity of mitral regurgitation, 4) selection of surgical intervention, 5) the choice of the surgeon whose expertise is best suited to perform the operation, 6) guidance of percutaneous mitral valve procedures, and 7) postoperative assessment. Accurate preoperative assessment of the …