ACCURACY OF REAL-TIME 3D ECHOCARDIOGRAPHY IN ASSESSING THE ANATOMY OF THE MITRAL VALVE IN PATIENTS UNDERGOING SURGERY FOR SEVERE DEGENERATIVE MITRAL REGURGITATION

Background. Accurate preoperative assessment of mitral valve (MV) morphology and function is essential to predict the likelihood of surgical repair and plan surgical approach. 2D transthoracic (2DE) and transesophageal echo require mental integration of MV leaflet morphology and have spatial limitations that may be overcome by real-time 3D echo (RT3DE).
Method. We compared 2DE and  RT3DE reconstruction of MV anatomy with surgical findings in  61 consecutive pts (69±10 yrs, 57% males) undergoing surgery for severe degenerative mitral regurgitation. 3D volume rendered en-face views of the MV from the atrium and the ventricle were reconstructed offline unaware of 2DE and surgical findings. Surgical findings: involved MV leaflet (63% single posterior leaflet, and 11% single anterior leaflet), individual scallop involvement (48% isolated P2 and 11% isolated A2), chordal rupture (72%), and presence of flail leaflet (28%).
Results. 25 pts were excluded: 17 for atrial fibrillation and 8 for poor quality of 3D reconstruction (Feasibility= 59%). In table diagnostic accuracy of 2DE and RT3DE in the remaining 36 pts. Accuracy of the 2 techniques was similar in identification of single leaflet lesions, particularly if P2 was involved. 3DE was more accurate in more complex MV lesions.

	2DE	RT3DE	p
Culprit leaflet	78%	96%	0.021
Involved scallop	63%	93%	0.016
Flail leaflet	82%	85%	NS
Chordal rupture	80%	67%	NS

Conclusions. RT3DE en face views of the MV showed excellent concordance with surgical inspection in identifying the culprit leaflet and the involved scallops. Limited spatial resolution of RT3DE may explain the limited accuracy of the technique in identifying chordal rupture. In addition, RT3DE provides easily interpretable images that facilitate communication with surgeons and non-echocardiographers.