Surgery

The aims of this study were to evaluate the feasibility of real-time 3-dimensional (3D)transesophageal echocardiography in the intraoperative assessment of valvular pathology and to compare this novel technique with 2-dimensional (2D) transesophageal echocardiography.

Methods: 1450 consecutive patients undergoing valvular were studied prospectively. Intraoperative 2D and 3D transesophageal echocardiographic (TEE) examinations wereperformed using a recently introduced TEE probe that provides real-time 3D imaging. Expert echocardiographersblinded to 2D TEE findings assessed the etiology of MR on 3D transesophageal echocardiography.

Similarly, experts blinded to 3D TEE findings assessed 2D TEE findings. Both were compared with theanatomic findings reported by the surgeon.

Results: At the time of surgical inspection, ischemic MR was identified in 12% of patients, complex bileafletmyxomatous disease in 31%, and specific scallop disease in 25%, aortic stenosis in 20% and insuffitienty in 12% of patients. Three-dimensional TEE image acquisitionwas performed in a short period of time (60 _ 18 seconds) and was feasible in all patients. Three-dimensional TEE imaging was superior to 2DTEE imaging in the diagnosis of P1, A2, A3, and bileaflet disease (P _ .05), as well as in aortic stenosis and insuffitienty evaluation ( leaflet morphology).

Conclusions: Real-time 3D transesophageal echocardiography is a feasible method for identifying specific valvular pathology in the setting of complex disease and can be expeditiously used in the intraoperativeevaluation of patients undergoing valvular repair surgery. (J Am Soc Echocardiogr 2009;22:34-41.)

Keywords: Real-time 3D TEE, Mitral valve, Aortic Valve Diagnosis.