Three-Dimensional Echocardiography: Advancements in Qualitative and Quantitative Analyses of Mitral Valve Morphology in Mitral Valve Prolapse

Abstract

Degenerative mitral valve disease (MVD) is the leading cause of organic mitral regurgitation (MR), one of the most common valvular heart disease in western countries. Substantial progresses in the surgical treatment of degenerative MVD have improved life expectancy of patients with significant MR. However, prognosis, surgical decision and timing of surgery strongly depend on the accurate characterization of mitral valve (MV) anatomy and pathology and on the precise quantification of MR. Three-dimensional (3D) echocardiography, a major technological breakthrough in the field of cardiovascular imaging, provides several advantages over two-dimensional (2D) imaging in the qualitative and quantitative evaluations of MV apparatus. In this review, we focus on the contribution of this new modality to the diagnosis of degenerative MVD, the quantitative assessment of MR severity, the selection and monitoring of surgical and percutaneous procedures, the evaluation of procedural outcomes. The results of a systematic and exhaustive search of the existing literature, restricted to real-time 3D echocardiography in adults, are here reported.

Keywords: 3D-echocardiography; degenerative mitral valve disease; mitral valve prolapse; mitral valve repair.

Figure 1

Example of head-to-head comparison between 3D TTE (left) and 3D TEE (right) datasets in two cases of A2 prolapse (above) and P2 prolapse (below), imaged from the surgical view (left atrium)

Figure 2

Example of 3D TEE and corresponding reconstruction of mitral annulus and leaflets in a patient with fibroelastic deficiency (left) and in two patients with Barlow disease (right). In the first case, reconstruction clearly shows (red surface) the P2 prolapsed segment. The two Barlow cases with the same method are characterized by multiple scallop involvement of both leaflets identified by the red surfaces

Figure 3

Two examples of the complementary use of 3D color Doppler in two different patients with a more common and typical patterns (left case P2 prolapse) and an uncommon case with multiple scallop involvement. 3D TTE color Doppler dataset (left) clearly facilitates the identification of the origin of the jet (P2) and its measurement while in the complex case (right) TEE identifies multiple regurgitant jets