Abstract
Mitral regurgitation may develop when the leaflets or any other portion of the apparatus becomes abnormal. As the repair techniques for mitral valve disease evolved, so has the need for detailed and accurate imaging of the mitral valve prior to surgery in order to better define the mechanism of valve dysfunction and the severity of regurgitation. In patients with significant mitral valve disease who require surgical intervention, multiplane transesophageal echocardiogram (TEE) is invaluable for surgical planning. However, a comprehensive TEE in a patient with complex mitral valve disease requires great experience and skill. There is evidence to suggest that 3D echocardiography can overcome some of the limitations of 2D multiplane TEE and thus is crucial in evaluation of patients undergoing mitral valve surgery. In the following sections, we review some of the crucial 2D and 3D echo images necessary for evaluation of MR based on the Carpentier classification.
Highlights
The mitral valve apparatus is a complex structure made of the annulus, the leaflets, the chordae, the papillary muscles, and the left ventricular wall [1]
There is evidence to suggest that Three dimensional (3D) echocardiography can overcome some of the limitations of Two dimensional (2D) multiplane transesophageal echocardiogram (TEE) and is crucial in evaluation of patients undergoing mitral valve surgery [5,6,7]
Once the pathology has been identified as mitral valve prolapse, the echocardiographer must accurately determine the scallops involved 2D TEE can identify the diseased scallops by performing a detailed, multiplane assessment [16]
Summary
The mitral valve apparatus is a complex structure made of the annulus, the leaflets, the chordae, the papillary muscles, and the left ventricular wall [1]. Once the pathology has been identified as mitral valve prolapse, the echocardiographer must accurately determine the scallops involved 2D TEE can identify the diseased scallops by performing a detailed, multiplane assessment [16]. The echocardiographer should measure the coaptation-septum distance as this is one of the determinants of postoperative systolic anterior motion of mitral valve [17]; (Figure 12). This is when 3D TEE and multiplanar reconstruction (MPR) can be utilized to assess the true EROA In this 3D function, the echocardiographer can use the orthogonal planes of the regurgitant jet to obtain an en-face view of the vena contracta (Figure 20, Panel B and C) and can trace the EROA. In this example the EROA was in the severe range despite what the vena contracta showed
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