Abstract
This study sought to assess the value of two-dimensional (2D) transthoracic echocardiography (TTE), 2D xPlane imaging and three-dimensional (3D) TTE for the definition of the site and the extent of mitral valve (MV) prolapse. Fifty patients underwent transthoracic 2D, 2D xPlane and 3D echocardiography. With 2D xPlane a segmental analysis of the MV was performed, by making a lateral sweep across the MV coaptation line as seen in the parasternal short-axis view. Inter-observer agreement for specific scallop prolapse was for 2D xPlane excellent (97 %, kappa = 0.94) and for 3D TTE moderate (85 %, kappa = 0.67). The respective sensitivities of standard 2D TTE, 2D xPlane, and 3D TTE for the identification of the precise posterior scallop prolapse were for P1 92, 85, and 92 %, for P2 96, 96, and 82 %, and for P3 86, 81, and 71 %. In total, 5 (8 %) prolapsing MV scallops were missed by 2D TTE, 7 (12 %) by 2D xPlane, and 12 (20 %) by 3D TTE. The sensitivity of 3D TTE was significantly lower than standard 2D imaging (80 % versus 93 %, P < 0.05). The extent of P2 prolapse was under or overestimated in 5 patients with 2D xPlane and in 9 patients with 3D TTE. 2D xPlane imaging is an accurate, easy to use (compared to 3D TTE) and easy to interpret (compared to 2D and 3D TTE) imaging modality to study the site and the extent of MV prolapse.
Highlights
Mitral valve (MV) prolapse (MVP) is one of the most common valvular abnormalities in industrialized countries [1]
5 (8 %) prolapsing mitral valve (MV) scallops were missed by 2D transthoracic echocardiography (TTE), 7 (12 %) by 2D xPlane, and 12 (20 %) by 3D TTE
Many physicians are of the opinion that two-dimensional (2D) transthoracic echocardiography (TTE) is not reliable enough to provide the surgeon with the essential pre-operative information and consider transesophageal echocardiography (TEE) obligatory
Summary
Mitral valve (MV) prolapse (MVP) is one of the most common valvular abnormalities in industrialized countries [1]. Three-dimensional (3D) TTE has been developed; a technique that is thought to be able to define more precisely the site and extent of the prolapse in a non-invasive manner [6, 7]. With the 3D matrix transducer, it is possible to identify the prolapse site and the extent from multiple 2D xPlane views taken from a standard parasternal short axis view of the MV by simultaneous multiplane imaging (SMPI) [9, 10]. This technique requires less expertise and the spatial resolution is only minimally reduced compared to 3D imaging. This study sought to assess the value of 2D TTE, 2D xPlane imaging and 3D TTE for the definition of the site and the extent of MV prolapse in patients that underwent MV surgery
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