Abstract 754: Is Real-Time Three-Dimensional Transesophageal Echocardiography Useful for Assessment of Annuloplasty? An in vitro and vivo Validation
Background: The newly designed annuloplasty rings have a specific three dimensional (3D) structure to address the etiology of valvular disease, maximizing efficiency and reducing a repair failure. A two-dimensional (2D) transesophageal echocardiography (TEE) provides limited visualization of annuloplasty rings because of their 3D structures. We tested whether 3D TEE could be used to determine the 3D structure of annuloplasty rings and to guide 2D assessments.
Methods: Real-time 3D and 2D TEE was performed in a water tank to examine 6 different types of annuloplasty rings (GeoForm, Physio, Edwards MC3, St. Jude Semi-rigid, saddle rigid and Cosgrove-Edwards). 3D guided 2D measurements of the major and minor dimensions, perimeters and heights were compared with those measured by an electronic caliper in an in vitro study. 3D and 2D TEE images were acquired in six patients with valve repairs.
Results: 3D TEE accurately demonstrated the 3D structure (open, closed, flat or non-flat, Figure C, D⇓), whereas 2D TEE had limitations in determining the spatial orientation (Figure B⇓). No direct measurements could be performed in the 3D image due to the limitations of 3D dataset registration and calibration (Figure D⇓). With 3D guidance the accuracy of 2D measurements was validated in an vitro study using an electronic caliper (major dimensions 29±4.3 mm vs. 30±3.5 mm; minor dimensions 18±3.6 mm vs. 17±5.6 mm; heights 2.8±1.4 mm vs. 3.2±2.7 mm; perimeters 76±3.1 mm vs. 73±6.5 mm, n=6, all p values >0.05).
Conclusion: 3D TEE is useful in determining the 3D structure of annuloplasty rings and to guide quantitative 2D assessment. A combination of 2D and 3D technologies improves the accuracy.
This research has received full or partial funding support from the American Heart Association, National Center.