UTILITY OF 3-DIMENSIONAL ECHOCARDIOGRAPHY DURING BALLOON MITRAL VALVULOPLASTY

Objectives. We investigated the role of three-dimensional echocardiogr aphy in assessing mitral valve anatomy in greater detail in patients i mmediately before and after balloon mitral valvuloplasty (BMV). Backgr ound. Three-dimensional echocardiography is a recently developed, evol ving imaging technique that allows visualization of intracardiac struc tures from any perspective, Methods. We studied 19 patients undergoing BMV using transesophageal echocardiography (TEE) (Chicago, Illinois) to image the mitral valve. The TEE was interfaced to a TomTec three-di mensional workstation that allows electrocardiographic and respiratory cycle gated image acquisition. The acquired images are digitized, and after postprocessing a three-dimensional image is reconstructed. The mitral valve was viewed ''en-face'' as if looking up from the left ven tricle. Results. The mean mitral valve area (by pressure half-time fro m the Doppler of the two dimensional echocardiogram) increased after B MV from 0.86 +/- 0.06 cm(2) to 2.07 +/- 0.10 cm(2), p < 0.0001. This H as similar to the mitral valve areas obtained by planimetry from the t hree dimensional images. The three-dimensional reconstructions showed a complete commissural split in 10 patients and partial splitting in 9 patients. In three of the eight patients who had an increase in the a mount of mitral regurgitation secondary to BMV, the three-dimensional reconstructions were able to detect tears within the valve leaflet. On e leaflet tear actually extended up to the mitral valve annulus and wa s associated with the only case of severe mitral regurgitation. Conclu sions. The three dimensional echocardiographic reconstruction enabled visualization of the mitral valve so that commissural splitting and le aflet tears not seen on the two-dimensional echocardiogram became visi ble. (C) 1998 by the American College of Cardiology.