Role of intraoperative 3D TEE in surgical repair of degenerative mitral valve regurgitation

Objective: Segmental analysis of diseased mitral valves is important to predict a successful surgical valve repair. We assessed the comparative accuracy of intra-operative three dimensional (3D) and bi-dimensional (2D) transoesophageal echocardiography (TOE) in the evaluation of MV lesions when compared with intraoperative surgical segmental analysis. Materials and Methods: We enrolled 42 consecutive patients (mean age 70.5± 14 years, 12 female and 30 male) with severe MV regurgitation due to degenerative disease underwent MV repair. Complete 2D TOE and 3D TOE was performed before surgery. The findings obtained by the different echocardiographic techniques were compared with intraoperative segmental analysis performed by a single operating blinded to the 2D and 3D TOE findings until the end of his inspection. The sensitivity and specificity of echocardiographic evaluation of involved scallops were compared with surgical inspection. Results: 3D TOE allowed an accurate identification of all mitral lesions. Thirty-three patients had simple lesions at 3D TOE and underwent simple surgical procedure, 9 of patients had complex lesions and, in these cases, surgeons performed complex procedure. 3D TOE showed more sensitivity than 2D TOE in the analysis of the anterior leaflet (A), in particular for A3 lesion (100% vs 25%, p-value <0.001) and for complex lesion (100% vs 33.3%, p-value <0.009). Conclusions: 3D TOE allowed more accurate identification of MV lesions in comparison with 2D TOE. Highest accuracy was reached in the analysis of the anterior leaflet. 3D TOE should be regarded as an important adjunct to standard 2D TOE in decision regarding MV repair.