3-DIMENSIONAL ECHOCARDIOGRAPHY OF NORMAL AND PATHOLOGICAL MITRAL-VALVE - A COMPARISON WITH 2-DIMENSIONAL TRANSESOPHAGEAL ECHOCARDIOGRAPHY

Objectives. This study was done to ascertain whether three-dimensional echocardiography can facilitate the diagnosis of mitral valve abnorma lities. Background. The value of the additional information provided b y three-dimensional echocardiography compared with two-dimensional mul tiplane transesophageal echocardiography for evaluation of the mitral valve apparatus has not been assessed. Methods. Thirty patients with a variety of mitral valve pathologies (stenosis in 8, insufficiency in 12, prostheses in 10) and 20 subjects with a normal mitral valve were studied. Images were acquired using the rotational technique (every 2 degrees), with electrocardiographic and respiratory gating. From the t hree-dimensional data sets, cut planes were selected and presented in both two-dimensional format (anyplane echocardiography) and volume ren dered dynamic display. The data were compared with the original multip lane two-dimensional images. Different features of the mitral valve ap paratus were defined and graded by three observers for clarity of visu alization and confidence of interpretation as 1) inadequate, 2) suffic ient, or 3) excellent. Results. All the techniques provided good visua lization of the mitral valve (mean global scores +/- SD for multiplane , anyplane and volume-rendered echocardiography were 2.22 +/- 0.34, 2. 24 +/- 0.26 and 2.30 +/- 0.25, respectively). With volume-rendered ech ocardiography, the mitral valve apparatus was scored higher in patholo gic than in normal conditions (2.38 +/- 0.24 vs, 2.16 +/- 0.21, p < 0. 002). The spatial relationships between the mitral valve and other str uctures, leaflet mobility, commissures and orifice were scored higher by volume-rendered echocardiography. Prostheses were evaluated equally well by the three methods. Multiplane and anyplane echocardiography w ere superior for the evaluation of leaflet thickness, subvalvular appa ratus and annulus. Conclusions. Transesophageal three-dimensional echo cardiography facilitates imaging of some features of the mitral valve apparatus and provides additional information for comprehensive assess ment of mitral valve abnormalities.