Dynamic Indices of Mitral Valve Function Using Perioperative Three-Dimensional Transesophageal Echocardiography

• Published in: Journal of cardiothoracic and vascular anesthesia Vol. 28; no. 1; pp. 18 - 24
• Main Authors: Bartels, Karsten, MD, Thiele, Robert H., MD, Phillips-Bute, Barbara, PhD, Glower, Donald D., MD, Swaminathan, Madhav, MD, FASE, Kisslo, Joseph, MD, FASE, Burkhard Mackensen, G., MD, FASE
• Format: Journal Article
• Language: English
• Published: United States 01.02.2014
• Subjects: Adult; Aged; Anesthesia & Perioperative Care; Case-Control Studies; Critical Care; Echocardiography, Three-Dimensional - methods; Echocardiography, Transesophageal - methods; Female; Humans; Male; Middle Aged; Mitral Valve - diagnostic imaging; Mitral Valve Insufficiency - diagnostic imaging; Mitral Valve Insufficiency - physiopathology; Perioperative Care; 3D TEE; perioperative; computer applications; 2D TEE; echocardiography; mitral valve; ultrasound; dynamic indices
• ISSN: 1053-0770; 1532-8422
• DOI: 10.1053/j.jvca.2013.03.024

Objective Perioperative transesophageal echocardiography is essential for decision-making for mitral valve surgery. While two-dimensional transesophageal echocardiography represents the standard of care, tracking of dynamic changes using three-dimensional imaging permits assessment of morphologic and functional characteristics of the mitral valve. The authors hypothesized that quantitative three-dimensional analysis would reveal distinct differences among diseased, repaired, and normal mitral valves. Design Case-control observational clinical study. Setting Tertiary care hospital. Participants Using novel mitral valve quantification software, the authors retrospectively analyzed 80 datasets of cardiac surgery patients who underwent intraoperative transesophageal echocardiographic imaging. Twenty patients with degenerative mitral regurgitation were evaluated before and after mitral valve repair. Twenty patients had functional mitral regurgitation, and 20 patients had no mitral valve disease. Measurements and Main Results Primary outcome measures of dynamic mitral valve function were: 1) three-dimensional annulus area, 2) annular displacement distance, 3) annular displacement velocity, and 4) annular area fraction. Other mitral annular tracking indices, in addition to intraobserver reliability and interobserver agreement, also were reported. Annulus area was enlarged in degenerative and functional mitral regurgitation. Annular displacement distance was decreased in functional mitral regurgitation and repaired valves. Annular displacement velocity was decreased in functional mitral regurgitation. Annular area fraction was decreased in functional mitral regurgitation and repaired valves. Intraobserver reliability and interobserver agreement were high for all 4 analyzed indices. Conclusions Normal, functional regurgitant, degenerative, and repaired mitral valves have distinctly different dynamic signatures of anatomy and function as reliably determined by perioperative echocardiographic tracking.