Emerging technology| Volume 22, ISSUE 2, P292-298, April 2008

Download started.


Intraoperative Application of Geometric Three-Dimensional Mitral Valve Assessment Package: A Feasibility Study

      Objective: To study the feasibility of using 3-dimensional (3D) echocardiography in the operating room for mitral valve repair or replacement surgery. To perform geometric analysis of the mitral valve before and after repair.
      Design: Prospective observational study.
      Setting: Academic, tertiary care hospital.
      Participants: Consecutive patients scheduled for mitral valve surgery.
      Interventions: Intraoperative reconstruction of 3D images of the mitral valve.
      Results: One hundred and two patients had 3D analysis of their mitral valve. Successful image reconstruction was performed in 93 patients—8 patients had arrhythmias or a dilated mitral valve annulus resulting in significant artifacts. Time from acquisition to reconstruction and analysis was less than 5 minutes. Surgeon identification of mitral valve anatomy was 100% accurate.
      Conclusions: The study confirms the feasibility of performing intraoperative 3D reconstruction of the mitral valve. This data can be used for confirmation and communication of 2-dimensional data to the surgeons by obtaining a surgical view of the mitral valve. The incorporation of color-flow Doppler into these 3D images helps in identification of the commissural or perivalvular location of regurgitant orifice. With improvements in the processing power of the current generation of echocardiography equipment, it is possible to quickly acquire, reconstruct, and manipulate images to help with timely diagnosis and surgical planning.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Cardiothoracic and Vascular Anesthesia
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Chauvel C.
        • Bogino E.
        • Clerc P.
        • et al.
        Usefulness of three-dimensional echocardiography for the evaluation of mitral valve prolapse: An intraoperative study.
        J Heart Valve Dis. 2000; 9: 341-349
        • Duran C.M.
        TEE: The ‘roadmap’ for mitral valve repair.
        J Heart Valve Dis. 2006; 15: 521-523
        • Ahmed S.
        • Nanda N.C.
        • Miller A.P.
        • et al.
        Usefulness of transesophageal three-dimensional echocardiography in the identification of individual segment/scallop prolapse of the mitral valve.
        Echocardiography. 2003; 20: 203-209
        • Abraham T.P.
        • Warner Jr, J.G.
        • Kon N.D.
        • et al.
        Feasibility, accuracy, and incremental value of intraoperative three-dimensional transesophageal echocardiography in valve surgery.
        Am J Cardiol. 1997; 80: 1577-1582
        • Macnab A.
        • Jenkins N.P.
        • Ewington I.
        • et al.
        A method for the morphological analysis of the regurgitant mitral valve using three-dimensional echocardiography.
        Heart. 2004; 90: 771-776
        • Pepi M.
        • Tamborini G.
        • Maltagliati A.
        • et al.
        Head-to-head comparison of two- and three-dimensional transthoracic and transesophageal echocardiography in the localization of mitral valve prolapse.
        J Am Coll Cardiol. 2006; 48: 2524-2530
        • Shanewise J.S.
        • Cheung A.T.
        • Aronson S.
        • et al.
        ASE/SCA guidelines for performing a comprehensive intraoperative multiplane transesophageal echocardiography examination: Recommendations of the American Society of Echocardiography Council for Intraoperative Echocardiography and the Society of Cardiovascular Anesthesiologists Task Force for Certification in Perioperative Transesophageal Echocardiography.
        Anesth Analg. 1999; 89: 870-884
        • Carpentier A.
        Cardiac valve surgery—The “French correction”.
        J Thorac Cardiovasc Surg. 1983; 86: 323-337
        • Carpentier A.F.
        • Lessana A.
        • Relland J.Y.
        • et al.
        The “physio-ring”: An advanced concept in mitral valve annuloplasty.
        Ann Thorac Surg. 1995; 60 (discussion 85-86): 1177-1185
        • Maslow A.
        • Schwartz C.
        • Bert A.
        Pro: Single-plane echocardiography provides an accurate and adequate examination of the native mitral valve.
        J Cardiothorac Vasc Anesth. 2002; 16: 508-514
        • Lambert A.S.
        • Miller J.P.
        • Merrick S.H.
        • et al.
        Improved evaluation of the location and mechanism of mitral valve regurgitation with a systematic transesophageal echocardiography examination.
        Anesth Analg. 1999; 88: 1205-1212
        • Omran A.S.
        • Woo A.
        • David T.E.
        • et al.
        Intraoperative transesophageal echocardiography accurately predicts mitral valve anatomy and suitability for repair.
        J Am Soc Echocardiogr. 2002; 15: 950-957
        • Grewal K.S.
        • Malkowski M.J.
        • Kramer C.M.
        • et al.
        Multiplane transesophageal echocardiographic identification of the involved scallop in patients with flail mitral valve leaflet: Intraoperative correlation.
        J Am Soc Echocardiogr. 1998; 11: 966-971
        • Stewart W.J.
        • Currie P.J.
        • Salcedo E.E.
        • et al.
        Evaluation of mitral leaflet motion by echocardiography and jet direction by Doppler color-flow mapping to determine the mechanisms of mitral regurgitation.
        J Am Coll Cardiol. 1992; 20: 1353-1361
        • Salustri A.
        • Becker A.E.
        • van Herwerden L.
        • et al.
        Three-dimensional echocardiography of normal and pathologic mitral valve: A comparison with two-dimensional transesophageal echocardiography.
        J Am Coll Cardiol. 1996; 27: 1502-1510
        • Hozumi T.
        • Yoshikawa J.
        Three-dimensional echocardiography using a muliplane transesophageal probe: The clinical applications.
        Echocardiography. 2000; 17: 757-764