FEASIBILITY, ACCURACY, AND INCREMENTAL VALUE OF INTRAOPERATIVE 3-DIMENSIONAL TRANSESOPHAGEAL ECHOCARDIOGRAPHY IN VALVE SURGERY

In this prospective trial, intraoperative 5-dimensional (2-D) and 3-di mensional (3-D) transesophageal echocardiography (TEE) examinations we re performed on 60 consecutive patients undergoing cardiac valve surge ry. Both 2-D (including color flow and Doppler data) and 3-D images we re reviewed by blinded observers, and major valvular morphologic findi ngs recorded. In vivo morphologic findings were noted by the surgeon a nd all explanted valves underwent detailed pathologic examination. To test reproducibility, 6 patients also underwent 3-D TEE 1 day before s urgery. A total of 132 of 145 attempted acquisitions (91%) were comple ted with a mean acquisition time of 2.8 +/- 0.2 minutes. Acquisition t ime was significantly shorter in patients with regular rhythms. Recons tructions were completed in 121 of 132 scans (92%) and there was at le ast 1 good reconstruction in 56 of 60 patients (93%). Mean reconstruct ion time was 8.6 +/- 0.7 minutes. Mean effective 3-D time, which was t he time taken to complete an acquisition and a clinically interpretabl e reconstruction, was 12.2 +/- 0.8 minutes. Intraoperative 3-D echocar diography was clinically feasible in 52 patients (87%). Three-D echoca rdiography detected most of the major valvular morpho logic abnormalit ies, particularly leaflet perforations, fenestrations, and masses, con firmed on pathologic examination. Three-D echocardiography predicted a ll salient pathologic findings in 47 patients (84%) with good quality images. In addition, in 15 patients (25%), 3-D echocardiography provid ed new additional information not provided by 2-D echocardiography, an d in 1 case, 3-D echocardiographic findings resulted in a surgeon's de cision to perform valve repair rather than replacement. In several ins tances, 3-D echocardiography provided complementary morphologic inform ation that explained the mechanism of abnormalities seen on 2-D and co lor flow imaging. In the reproducibility subset, preoperative and intr aoperative 3-D imaging detected a similar number of findings when comp ared with pathology. Thus, in routine clinical intraoperative settings , 3-dimensional TEE is feasible, accurately predicts valve morphology, and provides additional and complementary valvular morphologic inform ation compared with conventional 2-D TEE, and is probably reproducible . (C) 1997 by Excerpta Medica, Inc.