3D Echocardiography3D Echocardiography

3D Transesophageal 3D Transesophageal echocardiography has become echocardiography has become practical for intraoperative usepractical for intraoperative use

Technology provides 3D Technology provides 3D visualization of MV and offers visualization of MV and offers options for MV measurements.options for MV measurements.

2010 meeting will have sessions 2010 meeting will have sessions discussing this technologydiscussing this technology

3D Echo Case #1

Degenerative Mitral Valve DiseaseMyxomatous Degeneration

Mid-esophageal four-chamber TEE view Mid-esophageal four-chamber TEE view with color flow doppler demonstrating with color flow doppler demonstrating

billowing prolapse of both mitral leaflets billowing prolapse of both mitral leaflets and significant mitral regurgitation and significant mitral regurgitation

consistent with myxomatous degeneration. consistent with myxomatous degeneration.

Real-time, three-dimensional TEE (IE33; Real-time, three-dimensional TEE (IE33; Matrix X7-2t; Philips Healthcare, Inc.) en-Matrix X7-2t; Philips Healthcare, Inc.) en-face view of the mitral valve from the left face view of the mitral valve from the left atrial perspective demonstrating billowing atrial perspective demonstrating billowing and diffuse prolapse of both mitral leaflets and diffuse prolapse of both mitral leaflets consistent with myxomatous degeneration.consistent with myxomatous degeneration.

Computer generated image of the mitral valve (Q-labs, Computer generated image of the mitral valve (Q-labs, Philips Heathcare, Inc) from the left atrial perspective Philips Heathcare, Inc) from the left atrial perspective

demonstrating billowing and diffuse prolapse of both mitral demonstrating billowing and diffuse prolapse of both mitral leaflets consistent with myxomatous degeneration.leaflets consistent with myxomatous degeneration.

Real-time, three-dimensional TEE (IE33; Real-time, three-dimensional TEE (IE33; Matrix X7-2t; Philips Healthcare, Inc.) en-Matrix X7-2t; Philips Healthcare, Inc.) en-face view of the mitral valve from the left face view of the mitral valve from the left

atrial perspective in this patient with atrial perspective in this patient with myxomatous degeneration following mitral myxomatous degeneration following mitral

valve repair with a posterior leaflet resection valve repair with a posterior leaflet resection and partial ring annuloplasty.and partial ring annuloplasty.

3D EchoCase #2

Functional Mitral Regurgitation

Mid-esophageal four-chamber TEE Mid-esophageal four-chamber TEE view with color flow doppler view with color flow doppler

demonstrating apical tethering of both demonstrating apical tethering of both anterior and posterior leaflet with a anterior and posterior leaflet with a

severe, central jet of mitral severe, central jet of mitral regurgitation. regurgitation.

Zoom image of the mitral valve from a Zoom image of the mitral valve from a mid-esophageal four-chamber TEE mid-esophageal four-chamber TEE imaging plane. Note the significant, imaging plane. Note the significant, bileaflet apical tethering which is bileaflet apical tethering which is typical in patients with functional typical in patients with functional

mitral regurgitation.mitral regurgitation.

Real-time, three-dimensional TEE Real-time, three-dimensional TEE (IE33; Matrix X7-2t; Philips (IE33; Matrix X7-2t; Philips

Healthcare, Inc.) en-face view of the Healthcare, Inc.) en-face view of the mitral valve from the left atrial mitral valve from the left atrial perspective in this patient with perspective in this patient with functional mitral regurgitation.functional mitral regurgitation.

Full volume, color flow Doppler, Full volume, color flow Doppler, three-dimensional TEE three-dimensional TEE

(IE33; Matrix X7-2t; Philips (IE33; Matrix X7-2t; Philips Healthcare, Inc.) en-face view of the Healthcare, Inc.) en-face view of the

mitral valve from the left atrial mitral valve from the left atrial perspective showing significant, perspective showing significant, central jet of mitral regurgitation.central jet of mitral regurgitation.

Computer generated image (Q-labs, Philips Heathcare,Inc) Computer generated image (Q-labs, Philips Heathcare,Inc) showing significant apical tethering of posterior and anterior showing significant apical tethering of posterior and anterior

mitral valve leaflets with large tenting volumemitral valve leaflets with large tenting volume

Real-time, three-dimensional TEE (IE33; Real-time, three-dimensional TEE (IE33; Matrix X7-2t; Philips Healthcare, Inc.) Matrix X7-2t; Philips Healthcare, Inc.)

en-face view of the mitral valve from the en-face view of the mitral valve from the left atrial perspective in this patient with left atrial perspective in this patient with functional mitral regurgitation following functional mitral regurgitation following

mitral valve repair with a full ring mitral valve repair with a full ring annuloplasty.annuloplasty.

Additional 3D Echoes FollowingAdditional 3D Echoes Following

MV NormalMV Normal

MV P2 Flail Pre-opMV P2 Flail Pre-op

MV P2 ProlapseMV P2 Prolapse

MV P3 Flail Pre-opMV P3 Flail Pre-op

MV P3 Flail Post-opMV P3 Flail Post-op

BarlowsBarlows

ReferencesReferences

Grewel J, Miller FA, et al: Real-Time Three-Dimensional Grewel J, Miller FA, et al: Real-Time Three-Dimensional Transesophageal Echocardiography in the Intraoperative Transesophageal Echocardiography in the Intraoperative Assessment of Mitral Valve Disease. J Am Soc Echocardiogr Assessment of Mitral Valve Disease. J Am Soc Echocardiogr 2009 Jan; 22(1):34-41.2009 Jan; 22(1):34-41.

Shernan SK: Intraoperative Three-Dimensional Shernan SK: Intraoperative Three-Dimensional Echocardiography: Ready for Primetime? J Am Soc Echocardiography: Ready for Primetime? J Am Soc Echocardiogr 2009 Jan 22(1)27A-28A.Echocardiogr 2009 Jan 22(1)27A-28A.

Salcedo EE, CarollJD, et al: A Framework fro Systemic Salcedo EE, CarollJD, et al: A Framework fro Systemic Characterization of the Mitral Valve by Real-Time Three-Characterization of the Mitral Valve by Real-Time Three-Dimensional Transesophageal Echocardiography. J Am Soc Dimensional Transesophageal Echocardiography. J Am Soc Echocardiogr 2009 Oct; 22(10):10870-99 Echocardiogr 2009 Oct; 22(10):10870-99