Title: Real-time three-dimensional transesophageal echocardiography : improvements in intraoperative mitral valve imaging
Authors : Hien, Maximilian Dominik
Rauch, Helmut
Lichtenberg, Artur
De Simone, Raffaele
Weimer, Marc
Ponta, Oriana
Rosendal, Christian
et. al : No
Published in : Anesthesia & Analgesia
Volume(Issue) : 116
Issue : 2
Pages : 287
Pages to: 295
Publisher / Ed. Institution : Lippincott Williams & Wilkins
Issue Date: 1-Feb-2013
License (according to publishing contract) : Licence according to publishing contract
Type of review: Peer review (publication)
Language : English
Subject (DDC) : 616: Internal medicine and diseases
Abstract: Background: Successful surgical repair of a regurgitant mitral valve (MV) is dependent on a comprehensive assessment of its complex anatomy. Although there is limited evidence of the feasibility and accuracy of intraoperative real-time 3-dimensional transesophageal echocardiography (RT3DTEE) in MV surgery, its use is increasing worldwide. We designed this prospective observational study of patients with mitral regurgitation to test initial findings on the accuracy of RT3DTEE images in the diagnosis of MV prolapse and chordal rupture relative to 2D imaging and to assess the potential of RT3DTEE for visualizing leaflet clefts. Methods: TEE-certified anesthesiologists examined 62 consecutive patients undergoing MV surgery by acquiring a full standard set of 2D TEE sections and 3D zoom recordings. Offline, 2D and 3D images were presented independently and in randomized order to 2 expert interpreters. Accuracy was determined using the surgical findings as the “gold standard.” Results: Surgical inspection identified 52 cases of MV prolapse (MVP). RT3DTEE correlated stronger with the surgical findings than 2D TEE for detection and localization of MVP (difference in proportions = 33.9%, P < 0.001) and chordal rupture (difference in proportions = 25.8%, P < 0.001). The superiority of RT3DTEE was significant for scallops A2, P1, P2 in MVP and A2, P2 in chordal rupture (all P < 0.05). In 22 patients, leaflet clefts were also surgically repaired, and RT3DTEE was feasible in accessing them (κ = 0.65, confidence interval [0.44, 0.81]). Conclusion: Although 2D TEE is currently the standard tool for intraoperative imaging in MV surgery, RT3DTEE improves the visualization of MV pathology and increases the accuracy of interpretation by facilitating spatial orientation. Further investigations, particularly those aimed at establishing its cost effectiveness, are indicated.
Departement: School of Management and Law
Organisational Unit: Institute of Public Management (IVM)
Publication type: Article in scientific journal
DOI : 10.1213/ANE.0b013e318262e154
ISSN: 0003-2999
URI: https://digitalcollection.zhaw.ch/handle/11475/17874
Appears in Collections:Publikationen School of Management and Law

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