Three-dimensional transesophageal echocardiography in the diagnosis of mitral valve prolapse

doi:10.1016/0002-8703(94)90754-4

American Heart Journal

Volume 128, Issue 6, Part 1, December 1994, Pages 1218-1224

https://doi.org/10.1016/0002-8703(94)90754-4 Get rights and content

Abstract

Because the anulus of the mitral valve is nonplanar in systole, false-positive diagnosis of mitral valve prolapse may result from two-dimensional transthoracic echocardiography. Because of the superior image quality of TEE, we used the three-dimensional TEE technique to evaluate the mitral valve in both normal subjects and patients with mitral valve prolapse and with ruptured chordae tendineae. After a conventional TEE examination, sequential images of longitudinal views were obtained by probe rotation. The images at 5-degree intervals were stored in machine cine memory loop; the special temporal images were selected with ECG gating and videorecorded. During the examination, 6 to 8 images of the left heart were recorded for later off-line, three-dimensional reconstruction. A total of 42 subjects were studied: 32 normal, 9 with mitral valve prolapse, and 1 with ruptured chordae tendineae. In normal subjects, three-dimensional TEE showed nonplanarity of the entire mitral valve, which assumes a saddle shape. In mitral valve prolapse, either the anterior or posterior leaflet protruded into the left atrium like a spoon; when both leaflets are involved, they prolapse like two spoons. The anterior and posterior leaflets coapted poorly, and there was a seam between them. In ruptured chordae tendineae the tip of the mitral leaflet protruded during systole into the left atrium far from the coaptation point and was perpendicular to the body of the mitral valve and parallel to the anterior and posterior walls of the left atrium. Three-dimensional TEE study gives a clear stereoscopic view of the mitral valve and provides accurate anatomic data for the mitral valve apparatus in both normal subjects and patients with mitral valve prolapse and with ruptured chordae tendineae. It helps define spatial location and extent of the vulvular deformities. Thus three-dimensional imaging in TEE provides a new perspective that will refine the diagnosis of mitral valve prolapse.

References (21)

X.-F. Wang et al.
Biplane transesophageal echocardiography: an anatomic-ultrasonic-clinical correlative study
Am Heart J
(1992)
X.-F. Wang et al.
Clinical application of three-dimensional transesophageal echocardiography
Am Heart J
(1994)
W. Markiewicz et al.
Effect of transducer placement on echocardiographic mitral valve motion
Am Heart J
(1978)
T.O. Cheng
Final word (?) for the diagnosis of mitral valve prolapse
Am J Cardiol
(1988)
R.A. Sochowski et al.
Comparison of accuracy of transesophageal versus transthoracic echocardiography for the detection of mitral valve prolapse with ruptured chordae tendineae (flail mitral leaflet)
Am J Cardiol
(1991)
M.D. Silberbach et al.
Three-dimensional echocardiographic reconstruction: from “ice-pick” view to virtual reality
T.O. Cheng et al.
Mitral leaflet billowing and prolapse: its prevalence around the world
Angiology
(1989)
T.O. Cheng
Mitral valve prolapse: an overview
J Cardiol
(1989)
R.A. Levine et al.
Three-dimensional echocardiographic reconstruction of the mitral valve, with implications for the diagnosis of mitral valve prolapse
Circulation
(1989)
R.A. Levine et al.
The relationship of mitral annular shape to the diagnosis of mitral valve prolapse
Circulation
(1987)

There are more references available in the full text version of this article.

Cited by (23)

Professor Xin-fang Wang from China is the Father of Modern Echocardiography
2012, International Journal of Cardiology
Citation Excerpt :
Soon thereafter, Professor Wang made extensive studies with, and published numerous articles on, monoplane, biplane and multiplane transesophageal echocardiography. I was privileged to collaborate with him on several publications [22,29–43]. There were over 50 textbooks on echocardiography published so far in China (Fig. 11).
Professor Xin-fang Wang from China is the Father of Modern Echocardiography
2011, International Journal of Cardiology
Recent advances in the echocardiographic diagnosis of mitral valve prolapse
2010, International Journal of Cardiology
Three-Dimensional Echocardiography. The Benefits of the Additional Dimension
2006, Journal of the American College of Cardiology
Citation Excerpt :
Since the early 1990s, the usefulness of 3D echocardiography has been shown in several areas, including: 1) direct evaluation of cardiac chamber volumes without the need for geometric modeling and without the detrimental effects of foreshortened views (26–41); 2) unique noninvasive realistic views of cardiac valves (13,42–58) and congenital abnormalities (59–71), extremely helpful for showing a variety of pathologies (72) and assessing the effectiveness of surgical or percutaneous transcatheter interventions (63,73–82); 3) direct 3D assessment of regional LV wall motion aimed at objective detection of ischemic heart disease at rest (37,83–86) and during stress testing (21,87), as well as quantification of systolic asynchrony to guide ventricular resynchronization therapy (88–92); 4) 3D color Doppler imaging with volumetric quantification of regurgitant lesions (18,67,93,94), shunts (95), and cardiac output (96,97); and 5) volumetric imaging and quantification of myocardial perfusion (98–102).
Over the past 3 decades, echocardiography has become a major diagnostic tool in the arsenal of clinical cardiology for real-time imaging of cardiac dynamics. More and more, cardiologists’ decisions are based on images created from ultrasound wave reflections. From the time ultrasound imaging technology provided the first insight into the human heart, our diagnostic capabilities have increased exponentially as a result of our growing knowledge and developing technology. One of the most significant developments of the last decades was the introduction of 3-dimensional (3D) imaging and its evolution from slow and labor-intense off-line reconstruction to real-time volumetric imaging. While continuing its meteoric rise instigated by constant technological refinements and continuing increase in computing power, this tool is guaranteed to be integrated in routine clinical practice. The major proven advantage of this technique is the improvement in the accuracy of the echocardiographic evaluation of cardiac chamber volumes, which is achieved by eliminating the need for geometric modeling and the errors caused by foreshortened views. Another benefit of 3D imaging is the realistic and unique comprehensive views of cardiac valves and congenital abnormalities. In addition, 3D imaging is extremely useful in the intraoperative and postoperative settings because it allows immediate feedback on the effectiveness of surgical interventions. In this article, we review the published reports that have provided the scientific basis for the clinical use of 3D ultrasound imaging of the heart and discuss its potential future applications.
Real-time 3-dimensional echocardiography: A review of the development of the technology and its clinical application
2005, Progress in Cardiovascular Diseases
Real-time 3-dimensional echocardiography (RT3DE) is a new imaging technique that can provide accurate, important, and additional information concerning cardiovascular morphology, pathology, and function. This article will review the development of the technology of RT3DE and its clinical application. As the technique continues to evolve, RT3DE is bound to play an increasingly important role in the diagnosis, prognosis, and treatment of patients with various forms of cardiovascular disease.
Comparison of accuracy of mitral valve area in mitral stenosis by real-time, three-dimensional echocardiography versus two-dimensional echocardiography versus doppler pressure half-time
2005, American Journal of Cardiology
Mitral valve area (MVA) in 30 patients with mitral stenosis (MS) and 34 normal controls was calculated by real-time, 3-dimensional echocardiography (RT3DE); MVA in patients with MS correlated well with the mitral area determined by 2-dimensional echocardiography (r = 0.98) and by pressure half-time (r = 0.90). MVA in normal controls on RT3DE correlated well with MVA on 2-dimensional echocardiography (r = 0.94) and pressure half-time (r = 0.91). There were significant differences between the orifice areas in patients with MS and normal controls. RT3DE can provide not only the anatomic structure of mitral valve apparatus, but also the optimal plane of the smallest mitral valve orifice, and can thus accurately measure the MVA.

View all citing articles on Scopus

View full text

Three-dimensional transesophageal echocardiography in the diagnosis of mitral valve prolapse

Abstract

Am Heart J

Am Heart J

Am Heart J

Am J Cardiol

Am J Cardiol

Mitral leaflet billowing and prolapse: its prevalence around the world

Angiology

Mitral valve prolapse: an overview

J Cardiol

Three-dimensional echocardiographic reconstruction of the mitral valve, with implications for the diagnosis of mitral valve prolapse

Circulation

The relationship of mitral annular shape to the diagnosis of mitral valve prolapse

Circulation