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Review
. 2021 Jul 8:8:706165.
doi: 10.3389/fcvm.2021.706165. eCollection 2021.

Two and Three-Dimensional Echocardiography in Primary Mitral Regurgitation: Practical Hints to Optimize the Surgical Planning

Maria Concetta Pastore  1   2 , Giulia Elena Mandoli  1 , Anna Sannino  3   4 , Aleksander Dokollari  5 , Gianluigi Bisleri  5 , Flavio D'Ascenzi  1 , Luna Cavigli  1 , Annalisa Pasquini  6 , Matteo Lisi  1   7 , Nicolò Ghionzoli  1 , Ciro Santoro  3 , Marcelo Haertel Miglioranza  8 , Marta Focardi  1 , Giuseppe Patti  2 , Serafina Valente  1 , Sergio Mondillo  1 , Matteo Cameli  1
Affiliations
Review

Two and Three-Dimensional Echocardiography in Primary Mitral Regurgitation: Practical Hints to Optimize the Surgical Planning

Maria Concetta Pastore et al. Front Cardiovasc Med. .

Abstract

Primary mitral regurgitation (MR) is the second most common valvular disease, characterized by a high burden in terms of quality of life, morbidity, and mortality. Surgical treatment is considered the best therapeutic strategy for patients with severe MR, especially if they are symptomatic. However, pre-operative echocardiographic evaluation is an essential step not only for surgical candidate selection but also to avoid post-operative complications. Therefore, a strong collaboration between cardiologists and cardiac surgeons is fundamental in this setting. A meticulous pre-operative echocardiographic exam, both with transthoracic or transesophageal echocardiography, followed by a precise report containing anatomical information and parameters should always be performed to optimize surgical planning. Moreover, intraoperative transesophageal evaluation is often required by cardiac surgeons as it may offer additive important information with different hemodynamic conditions. Three-dimensional echocardiography has recently gained higher consideration and availability for the evaluation of MR, providing more insights into mitral valve geometry and MR mechanism. This review paper aims to realize a practical overview on the main use of basic and advanced echocardiography in MR surgical planning and to provide a precise checklist with reference parameters to follow when performing pre-operative echocardiographic exam, in order to aid cardiologists to provide a complete echocardiographic evaluation for MR operation planning from clinical and surgical point-of-view.

Keywords: echocardiography; mitral regurgitation; planning; surgery; three-dimensional.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Left atrial strain in a healthy subject (Left) and in a patient with severe mitral regurgitation (Right). PACS, peak atrial contraction strain; PALS, peak atrial longitudinal (reservoir) strain.
Figure 2
Figure 2
Degenerative MR due to P2 flail in the context of a complex anatomy. (A) 2D images and relative 3D (on top) showing P2 leaflet flail form the long-axis view and commissural view. (B) Magnification of the 3D short-axis on the MV (surgeons' view), where the P2 flail is easily appreciated (red arrow), together with a deep indentation (cleft- yellow arrow) between P2 and P3, which justify the presence of multiple jets. (C) Color Doppler image of the long-axis view, showing at least 2 regurgitant MR jets.
Figure 3
Figure 3
Example of MV model, used to estimate inter-trigonal distance (T1-T2 distance in the top left panel; orange arrow) and thus MV ring size.
Figure 4
Figure 4
Algorithm to follow for preoperative evaluation of mitral regurgitation in order to promote the collaboration between cardiologist and cardiac surgeon and optimize surgical planning. LA, left atrial; LV, left ventricular; MV, mitral valve; TEE, transesophageal echocardiography; VCA, vena contracta area.
See this image and copyright information in PMC

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