Transthoracic echocardiography in patients undergoing mitral valve repair: comparison of new transthoracic 3D techniques to 2D transoesophageal echocardiography in the localization of mitral valve prolapse

Successful mitral valve (MV) repair for degenerative mitral regurgitation (DMR) is mainly related to surgical expertise and
MV anatomy. Although 2D echocardiography, specifically transoesophageal (TOE), provides precise information regarding
MV anatomy, recent advancements in matrix technology meant a decisive step forward to the point where segmental MV
analysis can be accurately performed from a noninvasive 3D transthoracic (TTE) approach. The aims of this study were: (a)
to evaluate the feasibility and time required for real-time 3D TTE in a large consecutive cohort of patients with severe DMR
in the assessment of MV anatomy; (b) to compare the accuracy of 3D TTE and 2D TOE versus surgical inspection in the
recognition and localization of all components of the MV leaflets; (c) to establish the added diagnostic value of 3D colour-
Doppler examination to pure 3D morphologic evaluation. 149 consecutive patients with severe DMR underwent complete
3D TTE before surgery and 2D TOE in the operating room. Echocardiographic data obtained by the different techniques were
compared with surgical inspection. 3D TTE was feasible in a relatively short time (8 ± 4 min), with good (49%) and optimal
(33%) imaging quality in the majority of cases. 3D TTE had significant better overall accuracy compared to 2D TOE (93
and 91%, p < 0.05, respectively). 2D TOE was significantly more specific than 3D TTE in the identification of A3 prolapse
(99 vs. 96%). The colourDoppler mode did not improve significantly the accuracy of 3D TTE, albeit it determined a better
sensitivity in the detection of A2 prolapse if compared to 2D TOE (95 vs. 85%). 3D TTE with or without colourDoppler
is a feasible and useful method in the analysis of MV prolapse; it allows a preoperative and noninvasive description of the
pathology as accurate as the 2D TOE.

成功实施二尖瓣（MV）修复术以治疗退行性二尖瓣关闭不全（DMR），主要依赖于手术技巧及MV解剖学知识。尽管二维超声心动图，特别是经食管超声（TOE），能提供有关MV解剖学的精确信息，但矩阵技术的最新进展使得从非侵入性的三维经胸超声（TTE）角度进行段状MV分析成为可能。本研究旨在：（a）评估实时三维TTE在连续大量患有严重DMR的患者群体中评估MV解剖学的可行性和所需时间；（b）比较三维TTE与二维TOE以及手术检查在识别和定位MV瓣叶所有组成部分的准确性；（c）确立三维彩色多普勒检查相对于纯三维形态学评估的额外诊断价值。149名连续患有严重DMR的患者在手术前接受了完整的3D TTE检查，并在手术室进行了二维TOE检查。通过不同技术获得的超声心动图数据与手术检查结果进行了比较。三维TTE在相对较短的时间内（8 ± 4分钟）即可实施，大多数病例的成像质量良好（49%）和最佳（33%）。与二维TOE相比，三维TTE的整体准确性显著提高（分别为93%和91%，p < 0.05）。在识别A3脱垂方面，二维TOE的特异性显著高于三维TTE（99% vs. 96%）。彩色多普勒模式并未显著提高三维TTE的准确性，尽管与二维TOE相比，它在检测A2脱垂方面具有更高的敏感性（95% vs. 85%）。无论是否采用彩色多普勒，三维TTE都是分析MV脱垂的一种可行且有效的方法；它允许在手术前进行非侵入性的病理描述，其准确性可与二维TOE相媲美。