Three-dimensional transesophageal echocardiography in the topical diagnosis of mitral valve lesions in patients with hemodynamically significant mitral insufficiency

Authors: Golukhova E.Z., Mashina T.V., Dzhanketova V.S., Mrikaev D.V

Company: Bakoulev National Medical Research Center for Cardiovascular Surgery, Moscow, 121552, Russian Federation

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Type:  Original articles


DOI: https://doi.org/10.24022/1997-3187-2020-14-4-339-348

For citation: Golukhova E.Z., Mashina T.V., Dzhanketova V.S., Mrikaev D.V. Three-dimensional transesophageal echocardiography in the topical diagnosis of mitral valve lesions in patients with hemodynamically significant mitral insufficiency. Creative Cardiology. 2020; 14 (4): 339–48 (in Russ.). DOI: 10.24022/ 1997-3187-2020-14-4-339-348

Received / Accepted:  03.12.2020 / 15.12.2020

Keywords: mitral valve mitral valve insufficiency, mitral valve prolapse, real-time three-dimensional transesophageal echocardiography, mitral valve quantification

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Abstract

Objective. To compare the sensitivity of detecting the localization of the affected segments of the mitral valve (MV) using two-dimensional transesophageal echocardiography (2D-TEE) and three-dimensional transesophageal echocardiography (3D-TEE) in patients with hemodynamically significant mitral regurgitation (MR) before and after surgery; to evaluate the effectiveness of valve-sparing surgery in the operating room.

Materials and methods. The study included 55 patients with degenerative mitral regurgitation (myxomatosis MV), which required surgical correction; 22 patients underwent reconstructive valve interventions, 33 – MV prosthetics. The control group included 20 people without MR or with MR up to 1 degree. In all patients, before the main stage of the operation, the segmental localization of the valve prolapses was determined intraoperatively using 2D and 3D-TEE techniques with the construction of a three-dimensional model of the MV. The results of the ultrasound examination were compared with the data of the surgical revision.

Results. The frequency of detection of prolapses using 3D-TEE compared to 2D-TEE in the operating room was significantly higher for segments A1 (p = 0.045), A2 (p = 0.043), P1 (p = 0.038), P3 (p = 0.039). After reconstructive interventions, all anatomical parameters of MV approached the standard values (p > 0.05 in comparison with the control group). Before and after the operation, there were significant changes in the following indicators: the height of the fibrous ring MV 9.0 ± 1.1 and 6.4 ± 1.7 mm (p = 0.0001), the height of the prolapse MV 6.4 ± 2.3 and 1.6 ± 0.9 mm (p = 0.0001), the volume of the prolapse of the MV 1.2 ± 0.3 and 0.15 ± 0.11 ml (p = 0.0001), the area of the MV 1482 ± 380.3 and 1058.3 ± 129.3 (p = 0.0001), the perimeter of the MC 144.3 ± 19.1 and 119.8 ± 9.3 (p = 0.0001).

Conclusions. The use of 3D-TEE in clinical practice can improve the results of topical diagnosis of the affected segments of the mitral valve in patients with hemodynamically significant MR and facilitate the choice of optimal surgical treatment tactics.

References

  1. Nkomo V.T., Gardin J.M., Skelton T.N. Burden of valvular heart diseases: a population-based study. Lancet. 2006; 368: 1005–11.
  2. Bockeria L., Mashina T., Golukhova E. Threedimensional echocardiography. Moscow; 2002: 5–27 (in Russ.).
  3. Pardi M.M., Pomerantzeff P.M.A., Sampaio R.O., Abduch M.C., Branda~o C.M.A., Mathias W., Jr. et al. Relation of mitral valve morphology to surgical repair results in patients with mitral valve prolapse: A three-dimensional transesophageal echocardiography study. Echocardiography. 2018; 35 (9): 1342–50. DOI: 10.1111/echo.14048
  4. Mit’kov V.V., Sandrikova V.A. Clinical guidelines for ultrasound diagnostics. Moscow; 1998: 86–119 (in Russ.)
  5. Mit’kov V.V. General ultrasound diagnostics. Moscow; 2011 (in Russ.)
  6. Buck Th., Plicht B. Cardiovasc Imaging Rep. Real-Time Three-Dimensional Echocardiographic assessment of severity of mitral regurgitation using iroximal isovelocity surface area and vena contracta area method lessons we learned and clinical implications. Curr. Cardiovasc. Imaging Rep. 2015; 8 (10): 38. DOI: 10.1007/s12410-015- 9356-7
  7. Schwammental E., Chen C. et al. Dynamics of mitral regurgitant flow fnd orifice area: Physiologic application of the proximal flow convergence method. Circulation. 1994; 90: 307.
  8. Baumgartner H., Falk V., Bax J.J, De Bonis M., Hamm Ch., Holm P.J. et al. 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur. Heart J. 2017; 38 (36): 2739–91. DOI: 10.1093/eurheartj/ehx391
  9. Zoghbi W.A., Adams D., Bonow R.O., EnriquezSarano M., Foster E., Paul A. Recommendations for noninvasive evaluation ofnative valvular regurgitationa report from the american society of echocardiography developed in collaboration with the society for cardiovascular magnetic resonance. J. Am. Soc. Echocardiogr. 2017; 30 (4): 303–71. DOI: 10.1016/j.echo.2017.01.007.
  10. Biaggi P., Jedrzkiewicz S., Gruner C. Quantification of mitral valve anatomy by threedimensional transesophageal echocardiography in mitral valve prolapse predicts surgical anatomy and the complexity of mitral valve repair. J. Am. Soc. Echocardiogr. 2012; 25: 758–65.
  11. Tabata M., Nishida H., Watanabe S., Uchimuro T., Takanashi S. Interscallop indentation closure as an adjunctive technique in mitral valve repair for degenerative mitral valve disease. Gen. Thorac. Cardiovasc. Surg. 2019. DOI: 10.1007/s11748-019-01177-5
  12. Sköldborg V., Madsen P.L., Dalsgaard M., Abdulla J. Quantification of mitral valve regurgitation by 2D and 3D echocardiography compared with cardiac magnetic resonance a systematic review and meta-analysis. Meta-Analysis Int. J. Cardiovasc. Imaging. 2020; 36 (2): 279–89. DOI: 10.1007/s10554-019-01713-7
  13. Vairo A., Marro M., Speziali G., Rinaldi M., Salizzoni S. “The Starry Sky”. A new intraprocedural three-dimensional echocardiographic technique. Echocardiography. 2019; 36 (9): 1765–8. DOI: 10.1111/echo.14474
  14. De Groot-de Laat L.E., Ren B., McGhie J., Oei F.B., Strachinaru M., Kirschbaum S.W. et al. The role of experience in echocardiographic identification of location and extent of mitral valve prolapse with 2D and 3D echocardiography. Int. J. Cardiovasc. Imaging. 2016; 32 (8): 1171–7. DOI: 10.1007/s10554-016-0895-z
  15. Golukhova E.Z., Mashina T.V., Dzhanketova V.S., Shamsiev G.A., Mrikaev D.V., Bockeria L.A. Three-dimensional transesophageal echocardiography in mitral valve reconstruction: the role and effectiveness. Creative Cardiology. 2016; 10 (1): 59–83. DOI: 10.15275/kreatkard.2016.01.06 (in Russ.)

About Authors

  • Elena Z. Golukhova, Dr. Med. Sc., Professor, Academician of RAS, Chief of Chair, Acting Head of Bakoulev National Medical Research Center for Cardiovascular Surgery, Deputy Chief Editor of the Journal, ORCID
  • Tatiana V. Mashina, Cand. Med. Sc., Senior Researcher, Ultrasonic Diagnostics Physician, ORCID
  • Violeta S. Dzhanketova, Cand. Med. Sc., Cardiologist, ORCID
  • David V. Mrikaev, Cand. Med. Sc., Cardiologist, ORCID

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, Director of Bakoulev National Medical Research Center for Cardiovascular Surgery