Elsevier

The Annals of Thoracic Surgery

Volume 90, Issue 6, December 2010, Pages 1922-1929
The Annals of Thoracic Surgery

Original article
Adult cardiac
Mitral Valve Morphology Assessment: Three-Dimensional Transesophageal Echocardiography Versus Computed Tomography

https://doi.org/10.1016/j.athoracsur.2010.06.116Get rights and content

Background

Advances in the minimally invasive mitral valve repair techniques increase the demands on accurate and reliable morphologic assessment of the mitral valve using three-dimensional imaging modalities. The present study compared mitral valve geometry measurements obtained by three-dimensional transesophageal echocardiography (TEE) to those obtained with multidetector row computed tomography (MDCT) used as a standard reference.

Methods

Clinical preoperative MDCT and intraoperative three-dimensional TEE were performed in 43 patients (mean age 81.0 ± 7.7 years) considered for transcatheter valve implantation procedure. Various measurements of mitral valve geometry were obtained from three-dimensional TEE datasets using mitral valve quantification software, and compared with those obtained from MDCT images using multiplanar reformation planes.

Results

Moderate and severe mitral regurgitation was present in 48.9% of patients. There was good agreement in mitral valve geometry measurements between three-dimensional TEE and MDCT without significant overestimation or underestimation and tight 95% limits of agreement. For linear dimensions, angles and areas, the 95% limits of agreement were less than 1 cm, less than 15 degrees, and less than 2 cm2, respectively. In addition, the intraclass correlation coefficients were more than 0.8 for all parameters. Finally, the measurements were highly reproducible, with low intraobserver and interobserver variability (nonsignificant overestimation or underestimation and narrow 95% limits of agreement).

Conclusions

The present study demonstrates the accuracy and clinical feasibility of the assessment of the mitral valve geometry with three-dimensional TEE that is comparable to the MDCT measurements. Three-dimensional TEE and MDCT provide accurate and complementary information in the evaluation of patients with mitral valve disease. Its potential incremental clinical value in the field of transcatheter mitral repair procedures needs further assessment in the future studies.

Section snippets

Patient Population

A total of 43 patients considered for transcatheter valve implantation procedure were prospectively included in the present study. Patients with history of mitral valve repair or replacement were excluded. All patients underwent a routine preoperative two-dimensional transthoracic echocardiography (TTE) to assess left ventricular and valvular function. The MDCT was performed to evaluate aortic and mitral valve anatomy before the intervention. In addition, TEE was performed routinely during the

Results

In all, 43 patients (mean age 81.0 ± 7.7 years; 60% men) were evaluated. Clinical and two-dimensional TTE characteristics of the patients are described in Table 1. Mean height, weight, and body mass index were 170.8 ± 7.6 cm, 75.1 ± 10.7 kg, and 25.7 ± 3.4 kg/m2, respectively.

Variable degrees of mitral regurgitation were present in 88.4% of patients, with 48.9% of the patients showing moderate or severe mitral regurgitation (Table 1). The average heart rate during TEE was 66.7 ± 13.3 beats per

Comment

The present study demonstrates that three-dimensional TEE allows for an accurate analysis of the mitral valve geometry as compared with the anatomical reference standard MDCT. In addition, three-dimensional TEE derived measurements were highly reproducible with good intraobserver and interobserver agreements. These findings indicate that three-dimensional TEE and MDCT may be complementary imaging tools to evaluate the mitral valve anatomy and geometry.

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