Use Of Three-dimensional Imaging Research Articles

Navicular bone fractures in horses: Prognosis after conservative and surgical treatment

The aim of this retrospective study is to describe and compare conservative and surgical treatment of navicular fractures in horses. An attempt is made to identify critical points that can favorably influence the prognosis of this orthopedic disease. All horses treated for a navicular fracture at the Equine Clinic, Vetsuisse Faculty, University of Zurich between 2005 and 2017 were included in this study. The severity of lameness at initial examination, radiographic assessment, hoof conformation, treatment (conservative or surgical), complications and outcome were determined from the medical records. Conservative and surgical treatment consisted of stable rest, a controlled exercise program and therapeutic orthopedic shoeing. During surgical treatment, fracture reduction was also carried out with a cortical screw. Computer assisted surgery were used in five horses and computer tomography in three horses. Follow-up examinations included clinical and radiographic examinations. The outcome was divided into three categories: 1 = very good; 2 = good; 3 = poor. Twelve horses met the inclusion criteria; Four horses were treated conservatively and eight were treated surgically. After conservative treatment, two horses (50 %) had a very good outcome and two (50 %) had a good outcome. After surgical treatment, four horses (50 %) had a very good outcome and four (50 %) had a poor outcome. Overall, 67 % of horses had a very good or good outcome, although radiographic signs of bone healing was not present in any of these cases. Various complications were identified, such as the fracture of a screw, the fragmentation of the small navicular bone fragment, the development of osteoarthrosis in the coffin joint and progressive podotrochosis. This study shows that the prognosis of navicular fractures is generally cautious and that degenerative changes to the navicular apparatus worsen the prognosis. In the present study, surgical treatment did not improve the prognosis of navicular fractures despite the intrasurgical use of three-dimensional imaging. However, technical advances could reduce the complication rate in the future.

Integration of Ultrasound in Image-Guided Adaptive Brachytherapy in Cancer of the Uterine Cervix

Cervical cancer continues to be a public health concern, as it remains the second most common cancer despite screening programs. It is the third most common cause of cancer-related death for women, and the majority of cases happen in developing nations. The standard treatment for locally advanced cervical cancer involves the use of external beam radiation therapy, along with concurrent chemotherapy, followed by an image-guided adaptive brachytherapy (IGABT) boost. The five-year relative survival rate for European women diagnosed with cervical cancer was 62% between 2000 and 2007. Updated cervical cancer treatment guidelines based on IGABT have been developed by the Gynecological working group, which is composed of the Group Européen de Curiethérapie–European Society for Therapeutic Radiology and Oncology. The therapeutic strategy makes use of three-dimensional imaging, which can be tailored to the target volume and at-risk organs through the use of computed tomography or magnetic resonance imaging. Under anaesthesia, the brachytherapy implantation is carried out. Ultrasonography is utilised to assess the depth of the uterine cavity and to facilitate the dilation of the uterine canal during the application insertion. In this study, we examine data from the international literature regarding the application of ultrasound in cervical cancer brachytherapy.

Evaluating 3D Simulation Accuracy for Breast Augmentation Outcomes: A Volumetric and Surface Contour Analysis in Chinese Patients.

The use of three-dimensional imaging in breast augmentation with silicone implants has revolutionized the surgery planning process by providing detailed visualizations of expected post-surgical outcomes. This technology enhances the decision-making process, enabling patients to choose their implants with greater confidence and ultimately leading to higher satisfaction with the postoperative outcome. This study aims to assess the accuracy of 3D imaging simulations using the Canfield Vectra XT 3D system in predicting breast augmentation outcomes in Chinese patients, focusing on volume, surface contour, breast anterior-posterior (AP) Projection, and breast internal angle. Our study analyzed female patients who received breast augmentation, documenting their preoperative and three-month postoperative conditions with 3D Vectra XT system images. Exclusions were made for patients undergoing concurrent breast surgeries or those with tuberous or ptotic breasts, due to limitations of the imaging system. Implants used were either round textured or anatomically shaped cohesive silicone gel, inserted subpectorally through trans-axillary or inframammary incisions, based on personalized evaluations. A detailed comparison between preoperative simulations and actual postoperative outcomes was conducted, focusing on volume, surface contour, AP projection, and internal angle variations. Statistical significance was determined through paired T tests, P < 0.05. In the analysis of preoperative simulations for determining postoperative outcomes in breast surgery, our study involving 42 Chinese patients, a total of 84 breasts, was conducted. The results indicated a mean volumetric discrepancy of 21.5 ± 10.3 (SD) cubic centimeters between the simulated and actual postoperative outcomes, achieving an accuracy rate of 91.9%. The root mean square deviation for the breast surface geometry was calculated to be 4.5 ± 1.1 (SD) millimeters (mm), demonstrating a low variance between the predicted and observed outcomes. The investigation found no significant variations across any specific areas of the breast surface, highlighting the uniform accuracy of the simulations across the entire breast. Additionally, the mean differences in Anterior-Posterior (AP) projection and internal angle were determined to be 8.82 ± 5.64 mm and 0.48 ± 1.91 (SD) degrees, respectively. These findings collectively attest to the efficacy of preoperative simulations in accurately predicting the postoperative physical appearance of breasts, thereby providing a valuable tool for surgical planning and improving the consultation process for patients. The Canfield Vectra XT 3D system has proven to be remarkably accurate in predicting the volumetric outcomes of breast augmentation surgery, with an accuracy rate exceeding 91.9%. It stands as a valuable tool for surgeons and patients alike, enhancing the preoperative planning process by offering a realistic preview of surgical results. This advancement not only facilitates a deeper understanding and setting of realistic expectations for patients but also strengthens the communication between patients and surgeons, ultimately leading to higher satisfaction rates with the surgical outcomes. It also emphasizes the significance of detailed documentation and consent processes in protecting against legal repercussions. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Usefulness of three-dimensional imaging in a flexible endoscopic surgery platform with multi-degrees-of-freedom articulating devices.

Recent studies on endoscopic submucosal dissection have aimed to reduce the difficulty of the procedure by using multi-degrees-of-freedom articulating devices. In this study, we evaluated the usefulness of adding three-dimensional (3D) video imaging into simulated endoscopic submucosal dissection tasks using multi-degrees-of-freedom devices. We designed an endoscopic platform with a 3D camera and two multi-degrees-of-freedom devices. Four ex vivo bench tasks were created, and a crossover study comparing 2D and 3D conditions was conducted on 15 volunteers. In each task, performance such as procedure time and accuracy were objectively evaluated. Additionally, a comprehensive visual analogue scale questionnaire was conducted. In the tasks simulating submucosal flap grasping, marking, and full-area incision, the use of 3D imaging significantly improved the speed and accuracy of the multi-degrees-of-freedom device manipulation (p < .01). No significant differences were observed in the task that simulated the dissection procedure. Furthermore, it appears that the accuracy of recognizing curved surfaces may be reduced in the 3D environment. Operators reported subjective increases in recognizability and operability with the 3D camera, along with an increase in asthenopia (p < .01). 3D vision improves the technical accuracy of certain simulated multi-degrees-of-freedom endoscopic submucosal dissection tasks and subjectively improved operating conditions, at the cost of increased eye strain.

Use of Biometric Images to Predict Body Weight and Hot Carcass Weight of Nellore Cattle.

The objective of this study was to evaluate different methods of predicting body weight (BW) and hot carcass weight (HCW) from biometric measurements obtained through three-dimensional images of Nellore cattle. We collected BW and HCW of 1350 male Nellore cattle (bulls and steers) from four different experiments. Three-dimensional images of each animal were obtained using the Kinect® model 1473 sensor (Microsoft Corporation, Redmond, WA, USA). Models were compared based on root mean square error estimation and concordance correlation coefficient. The predictive quality of the approaches used multiple linear regression (MLR); least absolute shrinkage and selection operator (LASSO); partial least square (PLS), and artificial neutral network (ANN) and was affected not only by the conditions (set) but also by the objective (BW vs. HCW). The most stable for BW was the ANN (Set 1: RMSEP = 19.68; CCC = 0.73; Set 2: RMSEP = 27.22; CCC = 0.66; Set 3: RMSEP = 27.23; CCC = 0.70; Set 4: RMSEP = 33.74; CCC = 0.74), which showed predictive quality regardless of the set analyzed. However, when evaluating predictive quality for HCW, the models obtained by LASSO and PLS showed greater quality over the different sets. Overall, the use of three-dimensional images was able to predict BW and HCW in Nellore cattle.

Application of Moving Target Information Perception Technology in Intelligent Supervision System.

In order to solve the problems of inaccurate information collection, incomplete information collection, and inconsistency of collected images in traditional sports injury collection methods, an application method of moving target information perception technology in intelligent supervision system is proposed. By judging and analyzing the potential motion damage posture of the motion posture intelligent tracking images, the collected motion intelligence tracking images are judged. The intelligent tracking image matrix can make up for the shortcomings of traditional images that are not connected, complete the identification, detect potential damage in time, and take targeted preventive measures and means. Finally, according to the target detection algorithm and target tracking algorithm, combined with OpenCV computer vision library and QT image library, an intelligent video surveillance target tracking simulation system is developed. The algorithm studied in this paper is to realize the target tracking function of the intelligent video surveillance system. Through the comparison of experimental results, the design method can accurately collect damage attitude information, without calculating continuous values, and the use of three-dimensional images in the positioning process can analyze the damage attitude from multiple angles.

The use of three-dimensional imaging for R0 resection of a left upper lobe adenocarcinoma after coronary artery bypass surgery.

The use of three-dimensional imaging for R0 resection of a left upper lobe adenocarcinoma after coronary artery bypass surgery.

Anatomical characteristics of nasopalatine canal using cone beam computed tomography images

It is widely accepted that any interventional treatment, such as surgery, requires a precise and predetermined treatment plan. Moreover, conventional images do not allow for the presentation of all canal dimensions, and patients concepts of beauty and their expectations are greater for the premaxilla region. Therefore, the use of three-dimensional images is essential in surgical procedures, such as pathological lesions or implant placement surgeries. In cone-beam computed-tomography images, the nasopalatine canal was examined in sagittal, coronal, and axial planes. The diameters of nasopalatine and incisive foramina were separately measured, and the length of the nasopalatine canal was found by measuring the distance between the mid-levels of the nasopalatine foramen and incisive foramen. The shape of the canal was assessed in the sagittal and coronal planes in the mid-level of the canal. In addition, the shape of the canal and posterior borders were examined in the mid-level of the canal in the axial plane. The nasopalatine angle was measured as an anterior angle between the long axis of the canal and the hard palate. The number of canals in the midline and openings in each plane was also counted. The nasopalatine canal in the sagittal plane was classified into six groups: conical (33.2%), cylindrical (25.6%), hourglass (24.7%), funnel-shaped (9.8%), reverse-cone (4.3%), and spindle (2.4%). In the coronal plane, the shape of the canal was assigned to three categories: single channel (59.2%), Y-shaped (31.2%), and dual-channel (9.6%), and the posterior border of the nasopalatine canal was classified into four groups: U-shaped (42.5%), V-shaped (37.2%), reverse-V-shaped (154%), and Y-shaped (4.9%). Finally, in the axial plane, the canal shape was classified into four groups: round (40.5%), oval (31.1%), heart-shaped (21.3%), and triangle-shaped (7%). The use of three-dimensional images should be strongly considered in all surgical interventions involving the nasopalatine canal, such as dental implant placement since any error in surgical interventions will bring about serious consequences due to higher aesthetic expectations for the anterior maxillary region. Due to the lack of correct diagnosis of canal morphology in conventional images, such as periapical and panoramic radiography, it seems necessary to use three-dimensional radiography when performing surgical interventions in this region.

Discussion: Use of Three-Dimensional Imaging to Assess the Effectiveness of Volume as a Critical Variable in Breast Implant Selection.

Oklahoma City, Okla. From private practice, Bajaj Plastic Surgery. Received for publication April 21, 2021; accepted June 29, 2021. Disclosure: The author has no financial interest to declare in relation to the content of this Discussion or of the associated article. Anureet K. Bajaj, M.D., M.B.A., 8106 North May Avenue, Suite B, Oklahoma City, Okla. 73120, [email protected], @bajajplasticsurgery

Use of Three-Dimensional Imaging to Assess the Effectiveness of Volume as a Critical Variable in Breast Implant Selection.

In breast augmentation, breast base diameter has been recognized as an important variable in implant selection. However, breast implant volume also has a tremendous impact on the final result. Previous methods of preoperative volume determination have been limited to external devices in a bra. Computer-based three-dimensional simulation technology now allows the physician to effectively communicate with the patient preoperatively regarding volume. A cohort of 40 consecutive patients underwent routine breast augmentation with either anatomically shaped or round implants. Five methods of preoperative volume determination including the Crisalix three-dimensional computer imaging system (Crisalix Virtual Aesthetics, Lausanne, Switzerland), along with an associated virtual reality tool, were used to assess the preoperative desires of the patients. A postoperative questionnaire was used to assess patient satisfaction with each volume determination method. Of the 40 patients, 100 percent were satisfied with their result; however, given the opportunity, 12 percent would have chosen a larger implant. The virtual reality tool and external sizers were shown to be the most effective in choosing an implant. The virtual reality tool was judged to be very helpful (62 percent), very accurate (78 percent), and important (88 percent) in helping patients choose their desired implant size. Prioritizing volume as an implant selection variable in breast augmentation results in a very high rate of patient satisfaction. Therapeutic, IV.

Clinical Features and the Use of Three-Dimensional Imaging for Unilateral Lambdoid Synostosis

True isolated lambdoid craniosynostosis is rare. It requires corrective surgery to prevent intracranial pressure and aesthetic stigma by significant dyscrania. We summarize our case series for lambdoid craniosynostosis outlining the pathophysiology, clinical findings and surgical approaches and outcomes. A retrospective analysis of our data from 2010 to 2020 summarized our cases of true lambdoid synostosis. We have used the medical notes and the radiological findings from computed tomography scans to summarize a case series of isolated lambdoid synostosis. Our case series demonstrated 7 patients with true isolated lambdoid craniosynostosis. In most cases surgical intervention in the form of posterior cranial vault remodeling utilizing a bandeau, based on occipital advancement techniques, has demonstrated the most consistently favorable aesthetic outcome. Surgical referral to a craniofacial center should be sought early in difficult to diagnose cases. Although rare, surgical intervention is indicated to correct potentially increased intracranial pressure and to ameliorate cranial dyscrania.

Polymethylmethacrylate cranioplasty implant customized using a polylactic acid mold and prepared with a 3D printer: an example case

In recent years, the use of three-dimensional imaging and modeling methods has become increasingly frequent, replacing two-dimensional studies. Three-dimensional images, which are widely used in medicine, provide surgical facilities, especially in neurosurgical practice. Surgery for epilepsy, cranioplasty, vascular and intracranial lesions could be shaped based on three-dimensional images. The main purpose of cranioplasty is to replace bone tissue loss due to previous surgery or trauma to protect brain tissue. For this purpose, autologous grafts could be used as well as materials such as polymethylmethacrylate. In this study, a PLA mold was produced using a three-dimensional printer for the patient who was planned for cranioplasty and cranioplasty was performed with PMMA. The perioperative observation of the patient revealed that the mold was fully seated. The patient was satisfied cosmetically in the follow-up. With the advancement of technology, the use of three-dimensional printers in neurosurgery practice will further increase, individual treatment methods will be developed and better results will be obtained with less cost and complication rates.

CT scan image segmentation based on hounsfield unit values using Otsu thresholding method

The use of medical images in diagnosing and analyzing various cases in the medical field is commonly used. In certain cases, the image used is not limited to two-dimensional images, but sometimes requires the use of three-dimensional images. CT scan image is an image that has several image slices that can be reconstructed into a three-dimensional image. In the reconstruction process, segmentation plays an important role to get a good reconstruction result and reduce the resulting noise. This study aims to develop a method used in CT scan image segmentation, with the hope that it can simplify the diagnosis process performed by doctors using two-dimensional images or those that have been constructed into three-dimensional images. The main method developed is the Otsu Thresholding method based on the threshold value, which is combined with the Hounsfield unit (HU) value which will be the input for the segmentation process. The image used is a thorax CT scan image with the final goal to get the results of heart segmentation. The results obtained based on the calculation of balanced accuracy for the 30 data tested had an average of 72.54%. The highest result of balanced accuracy for heart segmentation was obtained by data 4 of 77.43%, while the lowest result was obtained by data 29 of 69.1%.

Surgical treatment of chronic otitis media in children using three-dimensional imaging

The introduction of three-dimensional exoscopy has opened a new stage in microsurgery in recent years. Researchers from various specialties give mostly positive reviews. There are very few works on the use of three-dimensional imaging in otorhinolaryngology, and there are practically no such works on otosurgery. This article presents a short review of publications and our own clinical examples, which are the first detailed description of VITOM 3D KARL STORZ exoscope use for cholesteatoma surgery in children, published in the available world literature. The first experience allowed us to draw preliminary conclusions about the comparability of this method of intraoperative imaging with a microscope. In addition, we have identified additional benefits of the exoscope. Further research will make it possible to better adapt the technique to the peculiarities of otosurgery, and it should take its place in the arsenal of ENT surgeons, along with microscopy.

Advanced Medical Use of Three-Dimensional Imaging in Congenital Heart Disease: Augmented Reality, Mixed Reality, Virtual Reality, and Three-Dimensional Printing.

Three-dimensional (3D) imaging and image reconstruction play a prominent role in the diagnosis, treatment planning, and post-therapeutic monitoring of patients with congenital heart disease. More interactive and realistic medical experiences take advantage of advanced visualization techniques like augmented, mixed, and virtual reality. Further, 3D printing is now used in medicine. All these technologies improve the understanding of the complex morphologies of congenital heart disease. In this review article, we describe the technical advantages and disadvantages of various advanced visualization techniques and their medical applications in the field of congenital heart disease. In addition, unresolved issues and future perspectives of these evolving techniques are described.

Persistent Oral Infection Caused by an Iatrogenic Displacement of a Lower Third Molar Root to the Sublingual Space

ABSTRACTAim and objectiveDescribe a case of sublingual displacement of a root of the lower third molar, as well as highlight the importance of using appropriate complementary imaging tests and provide the clinician with information on how to prevent and treat this complication.BackgroundThe displacement of the lower third molar is an accidental event that can lead to serious complications, which is usually the cause of inadequate surgical technique.Case descriptionA 69-year-old man presented pain and trismus due to local infection 1 month after a tooth extraction. After a misdiagnosis of retained root and surgical exploration, a cone-beam computed tomography (CBCT) showed a displaced root into the sublingual tissues. A surgical procedure under local anesthesia was carried out to easily remove the displaced tooth root, which resulted in complete healing of soft tissues and disappearance of signs of local infection.ConclusionThe use of CBCT is essential for the identification and location of the dislocated tooth and the removal of the fragment, as it allows a three-dimensional assessment providing adequate surgical planning which resulted in complete remission of all symptoms.Clinical significanceFew reports have been published to describe this rare complication of dental extractions that support key points for proper management: (1) the use of three-dimensional imaging for proper evaluation and establishment of exact location; (2) careful surgical planning; (3) precise surgery. Successful tooth removal is the main goal of treatment, which usually results in control of associated signs and symptoms.How to cite this articleSousa NWA, de Moraes ATL, Guimarães DM,et al.Persistent Oral Infection Caused by an Iatrogenic Displacement of a Lower Third Molar Root to the Sublingual Space. J Contemp Dent 2019;9(3):155–158.

P166] Analysis of dose distribution in HDR endobronchial brachytherapy in 2D and 3D methods with the use of three-dimensional images

Purpose The purpose of this study is to estimation the dose distribution in HDR endobronchial brachytherapy in 2D and 3D methods with the use of three-dimensional images. Methods Conducted examination concerns patients diagnosed with non-small cell lung cancer, receiving palliative care in the Brachytherapy Department between 2011 and 2013. The treated group consisted of 31 patients treatment process have been based on 3D planning method for all patients. Firstly, the coverage of the PTV parameter in 2D i 3D for V85, V100 i V115 has been analysed. Then, the dosage that the critical organs would take in, both methods have been evaluated. In cases of heart, spinal cord and oesophagus, the examined dosage equalled D 0 , 1 cm 3 , D 1 cm 3 and D 2 cm 3 for each of the structures. Also the heart D20 has been examined as well as D5 for the healthy lung. The number of applied applicators have been evaluated in reference to the volume target. Results When analysing the charts comparing both methods, for the target area we can observe that in each case in 3D method – 50% of middle results are situated higher on the chart than in 2D method. This proves much higher degree of PTV coverage in 3D method. In all of the evaluated OaR volumes, doses were higher in the 3D method then in the 2D one. When analysing the comparison of OaR for both methods on box-plots we can see that the differences are not as significant as when comparing both methods for PTV. Based on completed analysis of OaR dosage in 2D and 3D methods, we learn that critical organs have received only slightly higher doses in the 3D method compared to the 2D one. Conclusions 1) Differences in dose median between 3D and 2D methods in HDR endobronchial brachytherapy for PTV amounted to 43,33% for V85, for V100 44,08%, whereas for V115 reached the value if 43,67% in favour of three-dimensional imaging planning method; 2) the patient’s survival time for the 3D method was 21 months and the 2D method was 5 months

Synchrotron inline phase contrast µCT enables detailed virtual histology of embedded soft-tissue samples with and without staining.

Synchrotron radiation micro-computed tomography (SRµCT) based virtual histology, in combination with dedicated ex vivo staining protocols and/or phase contrast, is an emerging technology that makes use of three-dimensional images to provide novel insights into the structure of tissue samples at microscopic resolution with short acquisition times of the order of minutes or seconds. However, the high radiation dose creates special demands on sample preparation and staining. As a result of the lack of specific staining in virtual histology, it can supplement but not replace classical histology. Therefore, the aim of this study was to establish and compare optimized ex vivo staining and acquisition protocols for SRµCT-based virtual histology of soft-tissue samples, which could be integrated into the standard workflow of classical histology. The high grade of coherence of synchrotron radiation allows the application of propagation-based phase contrast imaging (PBI). In this study, PBI yielded a strong increase in image quality even at lower radiation doses and consequently prevented any damage to the tissue samples or the embedding material. This work has demonstrated that the improvement in contrast-to-noise ratio by PBI enabled label-free virtual histology of soft-tissue specimens embedded in paraffin to a level of detail that exceeds that achieved with staining protocols.

Digital volume tomography : Dedicated scanner and cone beam CT with C‑arm systems

Digital volume tomography (DVT) and cone-beam computed tomography (CT) with C‑arm systems have become established three-dimensional imaging systems as an alternative to CT in some application areas. The technology of the systems is well developed so that they have become acompeting method to CT imaging in terms of image quality and radiation exposure. An advantage is the better spatial resolution, preferably with dedicated scanner systems, especially in the z direction. The radiation exposure of CT, cone beam CT and DVT are comparable, if the exposure parameter in CT imaging can be adjusted to the lower exposure levels. Advantages of these systems are that they can be used for imaging in abetter workflow or to acquire images under conditions not possible in CT, e. g. imaging under stress in orthopedics or to take images in the corona technique with ahorizontal gantry in cone-beam CT mammography PRACTICAL RECOMMENDATIONS: The use of three-dimensional imaging is becoming more frequent and will replace planar radiography in additional clinical situations. The three-dimensional imaging without superpositioning of structures has advantages in the visibility of structures and the spatial relation to other organs and structures. In guidelines and recommendations, the number of recommendations given for the use of three-dimensional imaging is increasing. This leads to asmall increase in the radiation exposure of patients, a trend which is reflected in the annual reports of the Federal Office for Radiation Protection.

Is pulmonary artery pressure a trigger of adverse outcome in mitral regurgitation?

Mitral regurgitation (MR) is an important cause of morbidity and mortality in developed countries (1,2). The most common cause of MR is degenerative with an age-related epidemiological burden consisting of a peak incidence in patients over 70 years of age (1). Open surgical correction, using mitral valve repair or replacement, is currently accepted as the standard treatment of MR. Congestive heart failure symptoms or left ventricular (LV) dysfunction (EF 40 or >45 mm according to ACC/AHA and ESC guidelines, respectively) are the suggested Class-I triggers for surgery (3,4). However, surgical treatment based on Class-I triggers may be characterized by a suboptimal postoperative outcome. Due to its long standing asymptomatic clinical course, the selection of optimal timing for surgery remains an important challenge (5-7). Due to the absence of randomized studies, current guidelines are based on the inference from observational studies or expert opinions. An ESC-position paper supports the organization of specialized valve clinics attempting optimal and individualized MR management (8). In the last few decades, the wide application of mitral valve repair has progressively changed the timing for surgery in patients with MR. Targeting valve lesion treatment, independent of symptoms and LV deterioration signs, mitral valve repair challenges the more conservative valve replacement approach, leading to early surgery in order to achieve an optimal postoperative outcome. The key points to consider are the predictability of repair using the best surgical strategy based on the functional mechanism of MR, the evaluation of MV repair efficacy before closing the chest, prediction and management of complications, and radicalization of MR treatment to achieve a durable repair without longterm recurrence or lesion progression. Mitral valve repair has been proposed for the treatment of MR without Class-I triggers when functional mitral anatomy matched with an experienced surgical team predicts a 95% rate of successful and durable repair with an expected surgical mortality <1%. Unlike the ACC/AHA statement, decision-making based on surgical reparability alone is not considered beneficial in the ESC recommendations (Class IIb). Although repair feasibility is considered a key point for early surgery in the real world the ultimate repair of degenerative MR is around 60%, with great inter-hospital variability related to team experience and intervention volume rate. The use of three-dimensional imaging may improve communication with surgeons, enabling them to predict a surgical strategy that might help close the gap between valve reparability and ultimate repair. New onset atrial fibrillation or resting pulmonary hypertension (PH) may be the facilitators of decision-making to perform mitral repair in asymptomatic MR with preserved LV function (Class IIa).