Real-Time Multiplanar Reconstruction Imaging Using 3-Dimensional Transesophageal Echocardiography in Structural Heart Interventions

Published:November 13, 2022DOI:
      The complexity of structural heart interventions has led to a demand for sophisticated periprocedural imaging guidance. Although traditional 2-dimensional (2D) transesophageal techniques are used widely, new-generation 3D ultrasound probes enable high temporal and spatial resolution. Multiplanar reconstruction of acquired 3D datasets has gained considerable momentum for precise imaging and to increase the validity of measurements. Previously, this technique was used after the acquisition of suitable 3D datasets. Recent advances in technology have enabled the use of live mode for multiplanar reconstruction across different ultrasound vendor platforms. The use of live multiplanar reconstruction can enhance the precision in real-time imaging, enable simultaneous visualization of structures of interest in multiple planes, reduce the need for probe manipulation, and thereby contribute to the success of the procedures. In this narrative review, the authors describe the rationale and utility for 3D transesophageal live multiplanar reconstruction, and outline its use for the structural heart interventions of mitral and tricuspid valve edge-to-edge repair, left atrial appendage occlusion, and the Lampoon procedure. A 3D transesophageal echocardiogram with live-multiplanar reconstruction has the potential to advance guidance of these complex interventions.

      Graphical abstract

      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


        • Mack M
        • Carroll JD
        • Thourani V
        • et al.
        Transcatheter mitral valve therapy in the United States.
        J Am Coll Cardiol. 2021; 78: 2326-2353
        • Stone GW
        • Lindenfeld J
        • Abraham WT
        • et al.
        Transcatheter mitral-valve repair in patients with heart failure.
        N Engl J Med. 2018; 379: 2307-2318
        • Gheorghe L
        • Rensing BJWM
        • der Heyden JASV
        • et al.
        Transcatheter tricuspid valve interventions: An emerging field.
        Curr Cardiol Rep. 2019; 21: 37
        • Lurz P
        • von Bardeleben RS
        • Weber M
        • et al.
        Transcatheter edge-to-edge repair for treatment of tricuspid regurgitation.
        J Am Coll Cardiol. 2021; 77: 229-239
        • Hahn RT
        • Saric M
        • Faletra FF
        • et al.
        Recommended standards for the performance of transesophageal echocardiographic screening for structural heart intervention: From the American Society of Echocardiography.
        J Am Soc Echocardiogr. 2022; 35: 1-76
        • Lee AP-W
        • Lam Y-Y
        • Yip GW-K
        • et al.
        Role of real time three-dimensional transesophageal echocardiography in guidance of interventional procedures in cardiology.
        Heart. 2010; 96: 1485-1493
        • Wang TKM
        • Harb SC
        • Miyasaka RL
        • et al.
        Live three-dimensional multiplanar reconstruction imaging guidance for concomitant mitral and tricuspid valve repairs using the MitraClip.
        CASE (Phila). 2020; 4: 119-126
        • Harb SC
        • Krishnaswamy A
        • Kapadia SR
        • et al.
        The added value of 3D real-time multiplanar reconstruction for intraprocedural guidance of challenging MitraClip cases.
        JACC Cardiovasc Imaging. 2020; 13: 1809-1814
        • Fan Y
        • Chan JSK
        • Lee AP-W.
        Advances in procedural echocardiographic imaging in transcatheter edge-to-edge repair for mitral regurgitation.
        Front Cardiovasc Med. 2022; 9864341
        • Zamorano JL
        • Badano LP
        • Bruce C
        • et al.
        EAE/ASE recommendations for the use of echocardiography in new transcatheter interventions for valvular heart disease.
        J Am Soc Echocardiogr. 2011; 24: 937-965
        • Flint N
        • Price MJ
        • Little SH
        • et al.
        State of the art: Transcatheter edge-to-edge repair for complex mitral regurgitation.
        J Am Soc Echocardiogr. 2021; 34: 1025-1037
        • Zoghbi WA
        • Asch FM
        • Bruce C
        • et al.
        Guidelines for the evaluation of valvular regurgitation after percutaneous valve repair or replacement: A Report from the American Society of Echocardiography Developed in Collaboration with the Society for Cardiovascular Angiography and Interventions, Japanese Society of Echocardiography, and Society for Cardiovascular Magnetic Resonance.
        J Am Soc Echocardiogr. 2019; 32: 431-475
        • Kodali S
        • Hahn RT
        • George I
        • et al.
        Transfemoral tricuspid valve replacement in patients with tricuspid regurgitation TRISCEND study 30-day results.
        JACC Cardiovasc Interventions. 2022; 15: 471-480
        • Hahn RT
        • Nabauer M
        • Zuber M
        • et al.
        Intraprocedural imaging of transcatheter tricuspid valve interventions.
        JACC Cardiovasc Imaging. 2019; 12: 532-553
        • Hahn RT
        • Weckbach LT
        • Noack T
        • et al.
        Proposal for a standard echocardiographic tricuspid valve nomenclature.
        JACC Cardiovasc Imaging. 2021; 14: 1299-1305
        • Vismara R
        • Gelpi G
        • Prabhu S
        • et al.
        Transcatheter edge-to-edge treatment of functional tricuspid regurgitation in an ex vivo pulsatile heart model.
        J Am Coll Cardiol. 2016; 68: 1024-1033
        • Badano LP
        • Agricola E
        • de Isla LP
        • et al.
        Evaluation of the tricuspid valve morphology and function by transthoracic real-time three-dimensional echocardiography.
        Eur J Echocardiogr. 2009; 10: 477-484
        • Freitas-Ferraz AB
        • Bernier M
        • Vaillancourt R
        • et al.
        Safety of transesophageal echocardiography to guide structural cardiac interventions.
        J Am Coll Cardiol. 2020; 75: 3164-3173
        • January CT
        • Wann LS
        • Calkins H
        • et al.
        2019 AHA/ACC/HRS Focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation.
        Circulation. 2019; 140: e125-e151
        • Holmes DR
        • Reddy VY
        • Turi ZG
        • et al.
        Percutaneous closure of the left atrial appendage versus warfarin therapy for prevention of stroke in patients with atrial fibrillation: A randomised non-inferiority trial.
        Lancet. 2009; 374: 534-542
        • Reddy VY
        • Sievert H
        • Halperin J
        • et al.
        Percutaneous left atrial appendage closure vs warfarin for atrial fibrillation: A randomized clinical trial.
        JAMA. 2014; 312: 1988-1998
        • Vainrib AF
        • Harb SC
        • Jaber W
        • et al.
        Left atrial appendage occlusion/exclusion: Procedural image guidance with transesophageal echocardiography.
        J Am Soc Echocardiogr. 2018; 31: 454-474
        • Wunderlich NC
        • Beigel R
        • Swaans MJ
        • et al.
        Percutaneous interventions for left atrial appendage exclusion options, assessment, and imaging using 2D and 3D echocardiography.
        JACC Cardiovasc Imaging. 2015; 8: 472-488
        • Alkhouli M
        • Rihal CS
        • Holmes DR.
        Transseptal techniques for emerging structural heart interventions.
        JACC Cardiovasc Interventions. 2016; 9: 2465-2480

      Linked Article

      • Real-Time Multiplanar Reconstruction As a Standard Imaging Modality for Structural Heart Procedural Guidance
        Journal of Cardiothoracic and Vascular Anesthesia
        • Preview
          THE NUMBER OF TRANSCATHETER procedures for structural heart disease has increased dramatically over the past 10 years. According to the Society of Thoracic Surgeons-American College of Cardiology Transcatheter Valve Registry, in 2014, slightly more than 1,100 mitral valve transcatheter edge-to-edge repairs (MV TEER) and 84 transcatheter mitral valve replacements were performed. Data from 2019 estimate these numbers to be approximately 10,400 and 1,100, respectively, demonstrating a substantial increase in these types of cases.
        • Full-Text
        • PDF