Two and three-dimensional transesophageal echocardiography for pre-operative assessment of mitral valve morphology and regurgitation severity

Abstract

Background: Two-dimensional (2D) transthoracic (TTE) and transesophageal echocardiography (TEE) are the two main diagnostic modalities used to assess valvular heart diseases, particularly for mitral valve injury. In patients who have the indication of mitral valve surgery, 2D TEE & TTE have some limitations in identifying valve lesions. Three-dimensional transesophageal echocardiography (3D TEE) is more accurate than 2DTTE and 2DTEE in the qualitative assessment of mitral valve.

Objectives. Evaluating valve morphology and the severity of mitral valve regurgitation using 2DTTE and 2D/3D TEE in patients who required surgical intervention, compared to surgical and left ventricular angiography findings. Subjects: 44 patients with surgical indication from September 2017 to June 2018 were enrolled in this study.

Methods: A cross-sectional study conducted at Vietnam National Heart Institute from September 2017 to June 2018. 44 patients with mitral regurgitation who had indication for mitral valve surgery underwent 2D TEE and 2D/3D TEE before opened heart surgery for mitral valve, 17/44 had left ventriculogram during coronary angiogram before surgery.

Results: Men/women ratio = 2/1. Mean age: 54.14 ± 13.066 years old. Most of patients (93,2%) had symptoms of heart failure with mean NYHA classification of 2.55 ± 0.504. 3D TEE showed higher diagnostic accuracy and better agreement with surgical findings compared to 2D TEE and 2D TTE in A2 prolapse, A3 prolapse, P3 prolapse, Kappa =1,1,0.65 respectively. For anterior leaflet perforation, 3D TEE had positive predictive value of 100% and better agreement (Kappa =1) in comparison with 2D TEE and 2D TTE with positive predictive value of 96,5 %, Kappa = 0,65. In identifying valve vegetation, 3D TEE had positive predictive value of 93%, kappa =0,82 which were higher than those of 2D TEE and 2D TTE (positive predictive value of 89,6 % and Kappa = 0,73). In evaluating mitral valve regurgitation, 3D TEE had positive predictive value of 100%, kappa =1 compared with positive predictive value of 76,5%, kappa of 0,47 of 2D TEE and 2D TTE. Conclusions: 3D TEE is valuable in localizing prolapse valve segments, especially for A2, A3 and P3 prolapse, as well as in diagnosing anterior leaflet perforation and vegetation of mitral valve. 3D TEE is also more valuable than 2D TEE and 2D TTE in assessing mitral regurgitation severity.