Abstract 2662: Does Preoperative Three-dimensional Transthoracic Echocardiography with Multiplanar Reconstruction add Value in Patients with Mitral Valve Prolapse?
Background: Precise anatomic and mechanistic knowledge is necessary to determine the feasibility of mitral valve repair and which techniques will be necessary. In the majority of patients this information can be obtained by two-dimensional trans-thoracic echocardiography (2DTTE). But in complex prolapse or when the commissures are involved, acquisition and interpretation of 2D images can be challenging, where real-time 3D transthoracic echocardiography (3DTTE) with multiplanar reconstruction (MPR) may be useful in preoperative planning. Therefore we assessed the value of real-time 3DTTE in the management of patients undergoing mitral valve surgery for mitral valve prolapse.
Methods: Thirty patients with preoperative 2D and 3DTTE imaging were analyzed. The description of the mitral pathological anatomy obtained by 3DMPR was compared to that provided by 2DTTE in the context of the surgical findings to assess if 3DMPR influenced the reparability or surgical technique used.
Results: 2DTTE identified correctly the mechanism of regurgitation in 15/30 patients and 3DMPR in 19/30 patients (p=NS). In the 18 patients with complex pathology, i.e. more than isolated middle scallop of the posterior leaflet prolapse, 2DTTE identified only 6/18 correctly, as opposed 11/18 with 3DMPR (p<0.1 by Chi-square).
Conclusion: In patients with extensive and/or commissural prolapse, 2DTTE pathoanatomic and pathophysiological description of the prolapse was often incomplete. A strong trend toward improvement of the description was given by 3DTTE with MPR to a degree which changed the surgical reparative plan.