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Correlation of 2-Dimensional and 3-Dimensional Echocardiographic Analysis to Surgical Measurements of the Tricuspid Valve Annular Diameter

      Objective

      This study sought to determine if 3-dimensional (3D) echocardiography would more closely correspond to direct surgical measurements of the maximal tricuspid valve (TV) annular diameter than 2-dimensional (2D) measurements.

      Design

      Prospective study.

      Setting

      The cardiothoracic operating rooms (ORs) at Mount Sinai Medical Center in New York, NY.

      Participants

      Fifty-nine patients over 18 years of age underwent elective mitral valve surgery for severe mitral regurgitation from 2014 to 2015.

      Interventions

      None.

      Measurements and Main Results

      Two-dimensional and 3D data sets and surgical TV annular dimensions were measured. Bland-Altman analysis was conducted and absolute differences were compared using paired t tests and the McNemar test.
      The observed mean difference between the 2D measurements by transgastric right ventricular diastolic view and the surgical measurements was 0.21 cm (standard deviation [SD] = 0.36 cm); the mean difference between the 3D measurements and surgical measures was -0.03 cm (SD = 0.19 cm). The McNemar test showed that the rate of highly successful measurements, defined as those within 0.2 cm of the true surgical score, using the 3D technique (66%) was significantly better than the rate of highly successful measurements using the 2D technique (25%), p< 0.01, 2-sided.

      Conclusion

      Three-dimensional imaging and measurement of the TV annular diameter is feasible in the OR setting. The superiority of the 3D measurements versus 2D measurements allows for greater precision and accuracy and may guide better intraoperative surgical decision-making.

      Key Words

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      Linked Article

      • Intraoperative Measurement of the Tricuspid Annulus: To 3D or not to 3D?
        Journal of Cardiothoracic and Vascular AnesthesiaVol. 33Issue 1
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          TIME REMAINS a precious commodity for the cardiac anesthesiologist when performing a comprehensive echocardiography examination, and the question of whether to perform yet another 3-dimensional (3D) assessment technique in this regard is not new. In 2007, Culp et al. set out to validate cardiac output measurements by using a standard multiplanar probe and now obsolete 3D software.1 Although there was good correlation with thermodilution (correlation coefficient 0.86), an analysis time of 7 minutes made this technique impractical for cases involving unstable cardiac patients.
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