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Keywords = two-dimensional transesophageal echocardiography

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13 pages, 2439 KiB  
Article
Three-Dimensional Transesophageal Echocardiography Is Useful for Preventing Prosthetic-Patient Mismatch After Surgical Aortic Valve Replacement
by Kazuki Yoshida, Haruka Sasaki, Hiroyuki Takaoka, Moe Matsumoto, Yusei Nishikawa, Yoshitada Noguchi, Shuhei Aoki, Katsuya Suzuki, Satomi Yashima, Makiko Kinoshita, Noriko Suzuki-Eguchi, Shuichiro Takanashi, Kazuyuki Matsushita, Goro Matsumiya and Yoshio Kobayashi
J. Clin. Med. 2025, 14(13), 4762; https://doi.org/10.3390/jcm14134762 - 5 Jul 2025
Viewed by 305
Abstract
Introduction: Prosthesis-patient mismatch (PPM) in surgical aortic valve replacement (SAVR) is known to be a poor prognostic factor. However, the parameters for preventing postoperative PPM in SAVR have not been established. Materials and Methods: Two hundred and five patients (mean age [...] Read more.
Introduction: Prosthesis-patient mismatch (PPM) in surgical aortic valve replacement (SAVR) is known to be a poor prognostic factor. However, the parameters for preventing postoperative PPM in SAVR have not been established. Materials and Methods: Two hundred and five patients (mean age 72.5 ± 7.4 years, 129 males) who underwent SAVR were analyzed. Preoperatively, we determined the recommended prosthesis valve size from the mean aortic valve (AV) diameter derived from the AV annulus area by preoperative three-dimensional transesophageal echocardiography (3D-TEE). We investigated the association between pre- and postoperative changes in annulus diameter and the occurrence of PPM. Results: PPM was present in 6 patients (2.9%). Pre- and postoperative AV annulus diameter change ratio was greater in the group with PPM than in that without PPM (10.4 ± 3.6% vs. 3.0 ± 5.6%, p = 0.002). The use of prosthetic valve rings smaller than the recommended size was higher in the group with PPM than in that without PPM. (83.3% vs. 20.6%, p = 0.002). On multivariate logistic regression analysis, use of a valve smaller than the recommended size was an independent predictor of PPM (odds ratio 19.3, 95% confidence interval 2.14–174.5, p = 0.008). Conclusions: The recommended prosthetic AV size based on preoperative 3D-TEE is useful for determining the optimal prosthetic AV size to prevent PPM after SAVR. Full article
(This article belongs to the Section Cardiology)
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7 pages, 1118 KiB  
Article
Optimal Localization of the Foramen Ovale for Transseptal Puncture Using the Vertebral Body Units
by Dong Hoon Kang, Sung Eun Park, Jong Woo Kim, Seong Ho Moon, Ho Jeong Cha, Jong Hwa Ahn and Joung Hun Byun
Medicina 2025, 61(5), 896; https://doi.org/10.3390/medicina61050896 - 15 May 2025
Viewed by 370
Abstract
Background and Objectives: Although transesophageal or intracardiac echocardiography and radiofrequency needles are employed to guide transseptal puncture, their routine utilization is associated with substantial expense. No reports have analyzed the use of the foramen ovale position to effectively guide transseptal punctures on [...] Read more.
Background and Objectives: Although transesophageal or intracardiac echocardiography and radiofrequency needles are employed to guide transseptal puncture, their routine utilization is associated with substantial expense. No reports have analyzed the use of the foramen ovale position to effectively guide transseptal punctures on chest X-rays or computed tomography scout views, which are more cost-effective approaches to safely and effectively guide the procedure. We aimed to find the foramen ovale position on chest computed tomography scout views to effectively guide percutaneous transseptal punctures. Materials and Methods: The study population included 31 patients treated with extracorporeal membrane oxygenation (ECMO) for cardiogenic shock, 32 patients diagnosed with atrial fibrillation (AF) who underwent MDCT, and 197 patients who underwent MDCT for non-cardiac conditions. Vertebral body units, defined as the distance between two adjacent vertebral bodies (the sixth and seventh thoracic spines) inclusive of the intervertebral disk space, were used to express the distance from the carina to the foramen ovale on computed tomography scout views. Results: The mean vertebral body units, distance from the carina to the foramen ovale (carina–foramen ovale), and distance from the carina to the foramen ovale on chest computed tomography scout views (carina–foramen ovale vertebral body units−1) were 2.3 ± 0.2 cm, 6.9 ± 0.9 cm, and 3.0 ± 0.3, respectively. Multivariate analysis showed significant correlations between the carina–foramen ovale vertebral body units−1 and sex (β = 0.080; p = 0.028), body mass index (β = −0.020; p < 0.001), age (β = 0; p = 0.013), and the application of extracorporeal membrane oxygenation or the presence of atrial fibrillation (β = 0.130; p = 0.004). Conclusions: Although a three-dimensional approach was not employed, the foramen ovale position may serve as a radiologic guide in various clinical settings where transseptal punctures are required. This technique may be an effective aid in transseptal puncture procedures. Full article
(This article belongs to the Section Cardiology)
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20 pages, 38951 KiB  
Review
The Key Role of 3D TEE in Assessing the Morphology of Degenerative Mitral Valve Regurgitation
by Francesco Fulvio Faletra, Eluisa La Franca, Laura Anna Leo, Leyla Elif Sade, William Katz, Francesco Musumeci, Caterina Gandolfo, Michele Pilato and Manlio Cipriani
J. Cardiovasc. Dev. Dis. 2024, 11(11), 342; https://doi.org/10.3390/jcdd11110342 - 28 Oct 2024
Viewed by 2451
Abstract
Two-dimensional transthoracic echocardiography (2D TTE) and two-dimensional transesophageal echocardiography (2D TEE) are regarded as the main imaging techniques for the assessment of degenerative mitral valve regurgitation (DMVR). However, describing the complex morphology of DMVR with 2D TTE and 2D TEE remains at the [...] Read more.
Two-dimensional transthoracic echocardiography (2D TTE) and two-dimensional transesophageal echocardiography (2D TEE) are regarded as the main imaging techniques for the assessment of degenerative mitral valve regurgitation (DMVR). However, describing the complex morphology of DMVR with 2D TTE and 2D TEE remains at the very least challenging. Three-dimensional (3D) TEE is an ideal technique for illustrating the extremely variable morphology of DMVR, providing images of unparalleled quality in terms of anatomical detail. In this review, we describe the key role of 3D TEE in various morphological scenarios that reflect everyday experiences in an echocardiographic laboratory. We also discuss the growing role of 3D TEE in mitral valve (MV) transcatheter edge-to-edge repair (TEER) and new modalities such as photorealistic and transparent displays, surface rendering parametric color maps, new algorithms for MVR quantification, and the potential role of new mini-TEE probes in adult patients with DMVR. Full article
(This article belongs to the Special Issue Feature Papers in Imaging)
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16 pages, 10182 KiB  
Article
Perioperative Assessment and Clinical Outcomes of Percutaneous Atrial Septal Defect Closure with Three-Dimensional Transesophageal Echocardiography
by İbrahim Saraç and Oğuzhan Birdal
Diagnostics 2024, 14(16), 1755; https://doi.org/10.3390/diagnostics14161755 - 12 Aug 2024
Cited by 1 | Viewed by 2301
Abstract
Background/Objectives: To close the atrial septal defect (ASD) with the transcatheter method, correctly defining the defect and selecting the appropriate closure device size are the most critical steps for the procedure’s success. Although ASD can be successfully closed under the guidance of three-dimensional [...] Read more.
Background/Objectives: To close the atrial septal defect (ASD) with the transcatheter method, correctly defining the defect and selecting the appropriate closure device size are the most critical steps for the procedure’s success. Although ASD can be successfully closed under the guidance of three-dimensional (3D) transesophageal echocardiography (TEE) and two-dimensional (2D) TEE, measurement comparisons between different types of defects are still needed. Methods: Our study was designed retrospectively. Sixty-one patients who underwent transcatheter ASD closure with 2D TEE and 3D TEE between 2020 and 2024 were included. The patients were divided into three groups according to the defect shape: circular, oval, and complex; and the measurement results, perioperative process, and clinical outcomes were compared in each group. Results: The average age of the patients was 35.05 ± 13.87 years, and 41 (67.2%) were women. The average follow-up period of the patients was 15.3 ± 9.18 months. No statistical significance was observed in the comparison of measurements obtained with 3D TEE and 2D TEE in the circular and oval defect groups. The differences between the minimum defect diameters of complex defects measured by 2D TEE and 3D TEE (p: 0.037), IVC rims (p < 0.001), aortic rims (p: 0.012), and the differences between implanted device dimensions and the maximum defect diameters measured by both methods were compared; statistical significance was observed (p: 0.025). Conclusions: In circular and non-complex oval defects, it has been observed that the size of the closure device selected with 2D TEE or 3D TEE is optimal, and the procedure is practical and feasible. While the closure of complex ASDs with 3D TEE provides reliable and optimal results, using only 2D TEE in complex ASDs may lead to selecting a smaller-sized device. Full article
(This article belongs to the Special Issue Latest Developments in Echocardiography)
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21 pages, 9013 KiB  
Review
Three-Dimensional Transesophageal Echocardiography in Percutaneous Catheter-Based Cardiac Interventions
by Juan M. Farina, Timothy Barry, Reza Arsanjani, Chadi Ayoub and Tasneem Z. Naqvi
J. Clin. Med. 2023, 12(17), 5664; https://doi.org/10.3390/jcm12175664 - 31 Aug 2023
Cited by 2 | Viewed by 2719
Abstract
Cardiac structural and valve interventions have remained surgical procedures for several decades. The ability to directly visualize the region of interest during surgery made imaging of these structures pre- and postsurgery a secondary tool to compliment surgical visualization. The last two decades, however, [...] Read more.
Cardiac structural and valve interventions have remained surgical procedures for several decades. The ability to directly visualize the region of interest during surgery made imaging of these structures pre- and postsurgery a secondary tool to compliment surgical visualization. The last two decades, however, have seen rapid advances in catheter-based percutaneous structural heart interventions (SHIs). Due to the “blind” nature of these interventions, imaging plays a crucial role in the success of these procedures. Fluoroscopy is used universally in all percutaneous cardiac SHIs and helps primarily in the visualization of catheters and devices. However, success of these procedures requires visualization of intracardiac soft tissue structures. Due to its portable nature and rapid ability to show cardiac structures online, transesophageal echocardiography (TEE) has become an integral tool for guidance for all percutaneous SHI. Transcatheter aortic valve replacement—one of the earliest catheter-based procedures—while initially dependent on TEE, has largely been replaced by preprocedural cardiac CT for accurate assessment of valve sizing. Developments in echocardiography now allow live three-dimensional (3D) visualization of cardiac structures mimicking surgical anatomy during TEE. Besides showing actual 3D intracardiac structures, 3D-TEE allows visualization of the interaction of intracardiac catheters and devices with soft tissue cardiac structures, thereby becoming a “second pair of eyes” for the operator. Real-time 3D-TEE now plays an important role complementing multiplane two dimensional and biplane TEE during such interventions. In this review, we discuss the incremental role of 3D-TEE during various SHIs performed today. Full article
(This article belongs to the Section Cardiovascular Medicine)
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16 pages, 2936 KiB  
Article
The Early Effects on Tricuspid Annulus and Right Chambers Dimensions in Successful Tricuspid Valve Bicuspidization
by Gintarė Bieliauskienė, Ieva Kažukauskienė, Vilius Janušauskas, Aleksejus Zorinas, Kęstutis Ručinskas, Antanas Mainelis and Diana Zakarkaitė
J. Clin. Med. 2023, 12(12), 4093; https://doi.org/10.3390/jcm12124093 - 16 Jun 2023
Viewed by 1440
Abstract
Background: It is unclear to what degree of tricuspid annulus (TA) reduction is necessary to achieve good postoperative results in surgical bicuspidization. The study aimed to evaluate TA and right heart chamber’s dimensions before and after heart surgery; and to compare TA parameters [...] Read more.
Background: It is unclear to what degree of tricuspid annulus (TA) reduction is necessary to achieve good postoperative results in surgical bicuspidization. The study aimed to evaluate TA and right heart chamber’s dimensions before and after heart surgery; and to compare TA parameters assessed by different modalities. Methods: Forty patients underwent mitral valve surgery with or without concomitant tricuspid valve (TV) bicuspidization. Preoperative and postoperative measurements of TA dimensions were performed prospectively using two-dimensional (2D) and three-dimensional (3D) transthoracic echocardiography (TTE). Additionally, preoperative transesophageal echocardiography (TOE) was performed in the operating room prior to surgery. Results: All patients had no or mild TR immediately after surgery. There was a significant reduction in 2D and 3D parameters of the TV and right chambers in the TV bicuspidization group. However, TV leaflets’ tethering parameters did not change significantly. Preoperative 3D TTE measurements were smaller than those obtained through 3D TOE in the operation room, before surgery under general anesthesia. The 2D systolic apical 4Ch diameter and the parasternal short axis diameter mainly represent the 3D minor axis of the TA and are smaller than its 3D major axis. Conclusions: Although bicuspidization results in a one-third reduction of the TV area, tethering of the TV leaflets remains unchanged. Moreover, 3D TOE parameters of the TV under general anesthesia are larger than preoperative 3D TTE measurements. Conventional 2D measurements are insufficient for evaluating the maximum diameter of the TA. Full article
(This article belongs to the Section Cardiology)
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16 pages, 14884 KiB  
Article
Utilization of Two- and Three-Dimensional Transesophageal Echocardiography in Successfully Guiding Transcatheter Mitral Valve in Bioprosthetic Mitral Valve/Mitral Ring Implantation without Complications in Patients with Thrombus in Left Atrium/Left Atrial Appendage
by Zeyad M. Elmarzouky, Ming-Chon Hsiung, Amr Darwish, Subash Dulal, Bhanu Maturi, Wei-Hsian Yin, Yung-Tsai Lee, Tien-Ping Tsao, Jeng Wei and Navin C. Nanda
J. Clin. Med. 2022, 11(23), 7084; https://doi.org/10.3390/jcm11237084 - 29 Nov 2022
Viewed by 2249
Abstract
Background. The aim of this study is to describe, for the first time to our knowledge, the utilization of both two-dimensional (2D) and three-dimensional (3D) transesophageal echocardiography (TEE) in successfully performing transcatheter mitral valve (MV) in bioprosthetic MV/MV annulopasty ring implantation using the [...] Read more.
Background. The aim of this study is to describe, for the first time to our knowledge, the utilization of both two-dimensional (2D) and three-dimensional (3D) transesophageal echocardiography (TEE) in successfully performing transcatheter mitral valve (MV) in bioprosthetic MV/MV annulopasty ring implantation using the apical approach in 12 patients (pts) with co-existing left atrial appendage (LAA) and/or LA (left atrium) body thrombus, which is considered a contraindication for this procedure. Methods and Results. All pts were severely symptomatic with severe bioprosthetic MV stenosis/regurgitation except one with a previous MV annuloplasty ring and severe native MV stenosis. Thrombus in LAA and/or LA body was noted in all by 2D and 3DTEE. All were at high/prohibitive risk for redo operation and all refused surgery. Utilizing both 2D and 3DTEE, especially 3DTEE, guidewires and the prosthesis deployment system could be manipulated under direct vision into the LA avoiding any contact with the thrombus. The procedure was successful in all with amelioration of symptoms and no embolic or other complications over a mean follow-up of 21 months. Conclusion. Our study demonstrates the feasibility of successfully performing this procedure in pts with thrombus in LAA and/or LA body without any complications. Full article
(This article belongs to the Section Cardiology)
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12 pages, 4170 KiB  
Review
Real-Time Monitoring and Step-by-Step Guidance for Transcatheter Tricuspid Annuloplasty Using Transesophageal Echocardiography
by Yu Liu, Wei Li, Daxin Zhou, Xiaochun Zhang, Dehong Kong, Zhenyi Ge, Haiyan Chen, Xianhong Shu, Cuizhen Pan and Junbo Ge
J. Cardiovasc. Dev. Dis. 2022, 9(12), 415; https://doi.org/10.3390/jcdd9120415 - 25 Nov 2022
Cited by 5 | Viewed by 2525
Abstract
Transcatheter tricuspid valve intervention (TTVI) is a novel alternative to functional tricuspid regurgitation (FTR) for patients with prohibitive surgical risk. Devices have been designed according to different pathophysiological mechanisms of FTR, including ones to achieve an edge-to-edge repair and others aiming at direct [...] Read more.
Transcatheter tricuspid valve intervention (TTVI) is a novel alternative to functional tricuspid regurgitation (FTR) for patients with prohibitive surgical risk. Devices have been designed according to different pathophysiological mechanisms of FTR, including ones to achieve an edge-to-edge repair and others aiming at direct annuloplasty. Recently, a transcatheter tricuspid valve repair system mimicking a surgical Kay procedure (K-Clip™ system, Huihe Medical Technology, Shanghai, China) completed its salvage-use trial. The system, which clips the posterior annulus to achieve bicuspidization of the TV, demonstrated acceptable procedural safety and efficacy. Each TTVI system has distinct characteristics for echocardiographic imaging and special consideration for intraoperative guidance. This review focuses on elaborating how two-dimensional and three-dimensional transesophageal echocardiography (TEE) are used in clinical practice to guide K-Clip™ implantation in comparison to other direct annular reduction devices. A limited number of TEE work planes are proposed for the procedure with the aim to provide a steeper learning curve for the echocardiographer and interventionalist while simplifying the implantation steps. Full article
(This article belongs to the Special Issue Cardiac Imaging in Valvular Heart Disease)
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10 pages, 1357 KiB  
Article
Calculation of Aortic VAlve and LVOT Areas by a Modified Continuity Equation Using Different Echocardiography Methods: The CAVALIER Study
by Tobias Friedrich Ruf, Béatrice Elise Cannard, Ruth H. Strasser, Axel Linke and Krunoslav M. Sveric
Diagnostics 2022, 12(7), 1656; https://doi.org/10.3390/diagnostics12071656 - 7 Jul 2022
Cited by 5 | Viewed by 3167
Abstract
Background: The area of the left ventricular outflow tract (ALVOT) represents a major component of the continuity equation (CE), which is, i.a., crucial to calculate the aortic valve (AV) area (AAV). The ALVOT is typically calculated using 2D [...] Read more.
Background: The area of the left ventricular outflow tract (ALVOT) represents a major component of the continuity equation (CE), which is, i.a., crucial to calculate the aortic valve (AV) area (AAV). The ALVOT is typically calculated using 2D echo assessments as the measured anterior–posterior (a/p) extension, assuming a round LVOT base. Anatomically, however, usually an elliptical shape of the LVOT base is present, with the long diameter extending from the medial–lateral axis (m/l), which is not recognized by two-dimensional (2D) echocardiography. Objective: We aimed to compare standard and three-dimensional (3D)-echocardiography-derived ALVOT calculation and its use in a standard CE (CEstd) and a modified CE (CEmod) to calculate the AAV vs. computed tomography (CT) multi-planar reconstruction (MPR) measurements of the anatomical ALVOT, and AAV, respectively. Methods: Patients were selected if 3D transthoracic echocardiography (TTE), 3D transesophageal echocardiography (TEE), and cardiac CT were all performed, and imaging quality was adequate. The ALVOT was assessed using 2D calculation, (a/p only), 3D-volume MPR, and 3D-biplane calculation (a/p and m/l). AAV was measured using both CEstd and CEmod, and 3D-volume MPR. Data were compared to corresponding CT analyses. Results: From 2017 to 2018, 107 consecutive patients with complete and adequate imaging data were included. The calculated ALVOT was smaller when assessed by 2D- compared to both 3D-volume MPR and 3D-biplane calculation. Calculated AAV was correspondingly smaller in CEstd compared to CEmod or 3D-volume MPR. The ALVOT and AAV, using data from 3D echocardiography, highly correlated and were congruent with corresponding measurements in CT. Conclusion: Due to the elliptic shape of the LVOT, use of measurements and calculations based on 2D echocardiography systematically underestimates the ALVOT and dependent areas, such as the AAV. Anatomically correct assessment can be achieved using 3D echocardiography and adapted calculations, such as CEmod. Full article
(This article belongs to the Special Issue Echocardiography)
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10 pages, 6957 KiB  
Article
Multi-View 3D Transesophageal Echocardiography Registration and Volume Compounding for Mitral Valve Procedure Planning
by Patrick Carnahan, John Moore, Daniel Bainbridge, Elvis C. S. Chen and Terry M. Peters
Appl. Sci. 2022, 12(9), 4562; https://doi.org/10.3390/app12094562 - 30 Apr 2022
Cited by 2 | Viewed by 2296
Abstract
Three-dimensional ultrasound mosaicing can increase image quality and expand the field of view. However, limited work has been done applying these compounded approaches for cardiac procedures focused on the mitral valve. For procedures targeting the mitral valve, transesophageal echocardiography (TEE) is the primary [...] Read more.
Three-dimensional ultrasound mosaicing can increase image quality and expand the field of view. However, limited work has been done applying these compounded approaches for cardiac procedures focused on the mitral valve. For procedures targeting the mitral valve, transesophageal echocardiography (TEE) is the primary imaging modality used as it provides clear 3D images of the valve and surrounding tissues. However, TEE suffers from image artefacts and signal dropout, particularly for structures lying below the valve, including chordae tendineae, making it necessary to acquire alternative echo views to visualize these structures. Due to the limited field of view obtainable, the entire ventricle cannot be directly visualized in sufficient detail from a single image acquisition in 3D. We propose applying an image compounding technique to TEE volumes acquired from a mid-esophageal position and several transgastric positions in order to reconstruct a high-detail volume of the mitral valve and sub-valvular structures. This compounding technique utilizes both fully and semi-simultaneous group-wise registration to align the multiple 3D volumes, followed by a weighted intensity compounding step based on the monogenic signal. This compounding technique is validated using images acquired from two excised porcine mitral valve units and three patient data sets. We demonstrate that this compounding technique accurately captures the physical structures present, including the mitral valve, chordae tendineae and papillary muscles. The chordae length measurement error between the compounded ultrasound and ground-truth CT for two porcine valves is reported as 0.7 ± 0.6 mm and 0.6 ± 0.6 mm. Full article
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10 pages, 3999 KiB  
Review
Three-Dimensional Transesophageal Echocardiography in the Diagnosis and Treatment of Mitral Prosthetic Valve Endocarditis—A Narrative Review
by Vedran Carević, Zorica Mladenović, Ružica Perković-Avelini, Tina Bečić, Mislav Radić and Damir Fabijanić
Medicina 2022, 58(1), 23; https://doi.org/10.3390/medicina58010023 - 23 Dec 2021
Cited by 7 | Viewed by 4178
Abstract
Despite advances in diagnosis, imaging methods, and medical and surgical interventions, prosthetic valve endocarditis (PVE) remains an extremely serious and potentially fatal complication of heart valve surgery. Characteristic changes of PVE are more difficult to detect by transthoracic echocardiography (TTE) than those involving [...] Read more.
Despite advances in diagnosis, imaging methods, and medical and surgical interventions, prosthetic valve endocarditis (PVE) remains an extremely serious and potentially fatal complication of heart valve surgery. Characteristic changes of PVE are more difficult to detect by transthoracic echocardiography (TTE) than those involving the native valve. We reviewed advances in transesophageal echocardiography (TEE) in the diagnosis of PVE. Three-dimensional (3D) TEE is becoming an increasingly available imaging method combined with two-dimensional TEE. It contributes to faster and more accurate diagnosis of PVE, assessment of PVE-related complications, monitoring effectiveness of antibiotic treatment, and determining optimal time for surgery, sometimes even before or without previous TTE. In this article, we present advances in the treatment of patients with mitral PVE due to 3D TEE application. Full article
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8 pages, 1084 KiB  
Article
Mitral Valve Annulus Dimensions Assessment with Three-Dimensional Echocardiography Versus Computed Tomography: Implications for Transcatheter Interventions
by Kensuke Hirasawa, N. Mai Vo, Tea Gegenava, Stephan Milhorini Pio, Suzanne E. van Wijngaarden, Nina Ajmone Marsan, Jeroen J. Bax and Victoria Delgado
J. Clin. Med. 2021, 10(4), 649; https://doi.org/10.3390/jcm10040649 - 8 Feb 2021
Cited by 5 | Viewed by 3668
Abstract
The aim of this study is to evaluate the agreement between three-dimensional (3D) transesophageal echocardiography (TEE) and multidetector computed tomography (MDCT) for assessing mitral annular (MA) dimensions. A total of 105 patients (79 ± 9 years old, 52% male) who underwent clinically indicated [...] Read more.
The aim of this study is to evaluate the agreement between three-dimensional (3D) transesophageal echocardiography (TEE) and multidetector computed tomography (MDCT) for assessing mitral annular (MA) dimensions. A total of 105 patients (79 ± 9 years old, 52% male) who underwent clinically indicated 3D TEE and MDCT feasible for MA geometrical assessment were included. Using dedicated semi-automated postprocessing software, MA geometry, including mitral annular area (MAA), perimeter, septal-lateral (SL) diameter, and inter-trigonal (TT) diameter, was evaluated using 3D TEE and MDCT. Compared to 3D TEE, MAA, perimeter, and SL distance measured on MDCT data were larger (9.9 ± 3.0 vs. 9.3 ± 3.1 cm2 for MAA; 115 ± 18 vs. 108 ± 18 mm for perimeter; and 35 ± 5 vs. 32 ± 5 cm for SL distance, all p < 0.001). By contrast, the TT distance was comparable between MDCT and 3D TEE (26 ± 4 vs. 26 ± 4 cm, p = 0.258). The correlations of all the MA dimensions were good to excellent between the two modalities (R = 0.911 for MAA, 0.890 for perimeter, 0.739 for TT distance, and 0.857 for SL distance, respectively, all p < 0.001). This study showed good agreement between 3D TEE- and MDCT-derived MA measurements although MDCT systematically provided larger MAA, perimeter, and SL distance compared with 3D TEE. Full article
(This article belongs to the Special Issue Valvular Heart Disease: A World in Constant Motion)
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9 pages, 1896 KiB  
Article
Three-Dimensional Transesophageal Echocardiography as an Alternative to Multidetector Computed Tomography in Aortic Annular Diameter Measurements for Transcatheter Aortic Valve Implantation
by Ciprian Nicusor Dima, Marian Gaspar, Cristian Mornos, Aniko Mornos, Petru Deutsch, Horia Cioloca, Simona Cerbu, Mihai Dinu, Bogdan Hoinoiu, Constantin Tudor Luca and Lucian Petrescu
Biology 2021, 10(2), 132; https://doi.org/10.3390/biology10020132 - 8 Feb 2021
Cited by 6 | Viewed by 3761
Abstract
Background and objectives: Transcatheter aortic valve implantation (TAVI) is a therapeutic choice for high surgical risk patients, serving as an alternative to open-heart surgery. Correct measurement of the aortic annulus, which leads to the selection of a suitable prosthesis and accurate outcome prediction, [...] Read more.
Background and objectives: Transcatheter aortic valve implantation (TAVI) is a therapeutic choice for high surgical risk patients, serving as an alternative to open-heart surgery. Correct measurement of the aortic annulus, which leads to the selection of a suitable prosthesis and accurate outcome prediction, is essential for the success of TAVI. The objective of this study is to evaluate the accuracy of novel imaging te chniques in measuring the aortic annulus by comparing multi-detector computer tomography (MDCT) and three-dimensional transesophageal echocardiography (3D TEE) for the selection of the optimal prosthesis. Materials and Methods: Measurements of the aortic annulus have been performed on 25 patients using MDCT and TEE, and the correlation and agreement levels between the two measuring techniques were analyzed. MDCT measurements were used for the sizing of the prostheses. Results: MDCT and TEE measurements of aortic annular diameters were significantly correlated, with a mean difference of 0.001 cm. Conclusions: 3D TEE measurements have been in good agreement with MDCT and, therefore, 3D TEE can be used as an alternative in cases where MDCT is contraindicated or not available. Full article
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16 pages, 6142 KiB  
Review
Anatomy of Mitral Valve Complex as Revealed by Non-Invasive Imaging: Pathological, Surgical and Interventional Implications
by Laura Anna Leo, Vera Lucia Paiocchi, Susanne Anna Schlossbauer, Elisa Gherbesi and Francesco F. Faletra
J. Cardiovasc. Dev. Dis. 2020, 7(4), 49; https://doi.org/10.3390/jcdd7040049 - 4 Nov 2020
Cited by 6 | Viewed by 6340
Abstract
Knowledge of mitral valve (MV) anatomy has been accrued from anatomic specimens derived by cadavers, or from direct inspection during open heart surgery. However, today two-dimensional and three-dimensional transthoracic (2D/3D TTE) and transesophageal echocardiography (2D/3D TEE), computed tomography (CT) and cardiac magnetic resonance [...] Read more.
Knowledge of mitral valve (MV) anatomy has been accrued from anatomic specimens derived by cadavers, or from direct inspection during open heart surgery. However, today two-dimensional and three-dimensional transthoracic (2D/3D TTE) and transesophageal echocardiography (2D/3D TEE), computed tomography (CT) and cardiac magnetic resonance (CMR) provide images of the beating heart of unprecedented quality in both two and three-dimensional format. Indeed, over the last few years these non-invasive imaging techniques have been used for describing dynamic cardiac anatomy. Differently from the “dead” anatomy of anatomic specimens and the “static” anatomy observed during surgery, they have the unique ability of showing “dynamic” images from beating hearts. The “dynamic” anatomy gives us a better awareness, as any single anatomic arrangement corresponds perfectly to a specific function. Understanding normal anatomical aspects of MV apparatus is of a paramount importance for a correct interpretation of the wide spectrum of patho-morphological MV diseases. This review illustrates the anatomy of MV as revealed by non-invasive imaging describing physiological, pathological, surgical and interventional implications related to specific anatomical features of the MV complex. Full article
(This article belongs to the Special Issue Mitral Valve Development and Disease)
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8 pages, 700 KiB  
Article
Assessment of D-Shaped Annulus of Mitral Valve in Patients with Severe MR Using Semi-Automated 4-Dimensional Analysis: Implications for Transcatheter Interventions
by N. Mai Vo, Suzanne E. van Wijngaarden, Nina Ajmone Marsan, Jeroen J. Bax and Victoria Delgado
J. Cardiovasc. Dev. Dis. 2020, 7(4), 48; https://doi.org/10.3390/jcdd7040048 - 1 Nov 2020
Cited by 4 | Viewed by 3409
Abstract
The development of transcatheter mitral valve replacement therapies requires accurate post-processing analysis tools to provide D-shaped mitral annulus dimensions from 3-dimensional (3D) data. The agreement between two semi-automated, software packages to process 3D transesophageal echocardiography (TEE) data for the measurement of the mitral [...] Read more.
The development of transcatheter mitral valve replacement therapies requires accurate post-processing analysis tools to provide D-shaped mitral annulus dimensions from 3-dimensional (3D) data. The agreement between two semi-automated, software packages to process 3D transesophageal echocardiography (TEE) data for the measurement of the mitral valve annulus dimensions was evaluated. 3DTEE data of patients with moderate–severe mitral regurgitation (MR) were postprocessed with semi-automated, vendor-independent (VI) software and vendor-specific (VS) software. Both post-processing software provided key measurements for the selection of transcatheter valve prosthesis size: annulus area, annulus circumference and the septal-to-lateral distance of the annulus. The intertrigonal distance was provided only by the VS software. The inter- and intra-observer agreements were assessed with Bland–Altman analysis. Of 105 patients (63.8 ± 11 years, 66% male) with MR, 28 had secondary MR, 45 fibroelastic deficiency, and 32 Barlow’s disease. Using VS software, the dimensions for the overall population were 16.1 ± 4.6 cm2 for annulus area, for circumference 14.4 ± 1.9 cm, intertrigonal distance 3.4 ± 0.5 cm and septal-to-lateral distance 3.8 ± 0.6 cm. Similar dimensions were obtained using VI software: 15.7 ± 4.6 cm2 for annulus area, 14.5 ± 2.0 cm for circumference, and 4.1 ± 0.6 cm for septal-to-lateral distance. The inter- and intra-observer agreement for both software programs was excellent. In conclusion, current post-processing software programs for 3DTEE data of the mitral valve annulus provide good reproducibility of key measurements to select the transcatheter prosthesis size. Full article
(This article belongs to the Special Issue Mitral Valve Development and Disease)
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