BACKGROUNDLive three-dimensional transesophageal echocardiography (live-3D-TEE) is a new technique, but its clinical value is unclear at present. This study aimed to investigate the feasibility, imaging quality and accuracy of live-3D-TEE for assessing mitral valve morphology to determine if live-3D-TEE has important value in mitral valve surgery.

METHODSTwenty-four patients with mitral valve disease (mean age (47.1 +/- 11.6) years, mean weight (64.7 +/- 10.5) kg) underwent live-3D-TEE and two dimensional transesophageal echocardiography (2D-TEE) before and after mitral valve surgery. Sensitivity, specificity, and total consistency rates of live-3D-TEE for diagnosing ruptured chordae were calculated and compared to surgeon's findings. We also compared the diagnostic accuracy of mitral valve disease between live-3D-TEE and 2D-TEE.

RESULTSLive-3D-TEE allowed visualization of the anatomic structure of the heart online and clearly identified the valvular apparatus and their defects. Sensitivity and specificity for the detection of ruptured chordae by live-3D-TEE were 87.5% and 100% respectively, and the total consistency rate was 95.8%. Additional defects not diagnosted by 2D-TEE were found in three cases (12.5%) preoperatively by live-3D-TEE. Live-3D-TEE could evaluate the function of prosthetic or native valves immediately after operation. One case was re-repaired (4.2%) using guidance by live-3D-TEE.

CONCLUSIONLive-3D-TEE enabled evaluation of mitral valve function and provided adequate valuable information before and after mitral valve surgery. We conclude that live-3D-TEE can play an important role in mitral valve surgery.

Adult ; Aged ; Echocardiography, Transesophageal ; Female ; Heart Valve Diseases ; diagnostic imaging ; surgery ; Humans ; Male ; Middle Aged ; Mitral Valve ; surgery ; Mitral Valve Prolapse ; diagnostic imaging ; surgery ; Mitral Valve Stenosis ; diagnostic imaging ; surgery ; Sensitivity and Specificity

Aortic Valve Stenosis ; diagnostic imaging ; surgery ; Cardiac Surgical Procedures ; methods ; Echocardiography, Transesophageal ; methods ; Humans ; Infant, Newborn ; Male ; Mitral Valve ; diagnostic imaging ; surgery

OBJECTIVE: To retrospectively assess the value of intraoperative transesophageal echocardiography (TEE) during robotic mitral valve (MV) replacement. METHODS: Intraoperative TEE was performed in 21 patients undergoing robotic MV replacement for severe rheumatic mitral stenosis between November 2008 and December 2010. During the procedure, TEE was performed to document the mechanism of rheumatic mitral stenosis (leaflet thickening and calcification, commissural fusion or chordal fusion) before cardiopulmonary bypass (CPB). During the establishment of peripheral CPB, TEE was used to guide the placement of the cannulae in the inferior vena cava (IVC), superior vena cava (SVC), and ascending aorta (AAO). After weaning from CPB, TEE was performed to evaluate the effect of the procedure. RESULTS: Accuracy of TEE was 100% for rheumatic mitral stenosis. All the cannuli in the SVC, IVC and AAO were located in the correct position. In all patients, TEE confirmed successful procedure. CONCLUSION TEE is useful in the assessment of robotic MV replacement.
Adult ; Aged ; Cardiac Surgical Procedures ; methods ; Echocardiography, Transesophageal ; methods ; Female ; Heart Valve Prosthesis Implantation ; Humans ; Male ; Middle Aged ; Mitral Valve ; surgery ; Mitral Valve Stenosis ; diagnostic imaging ; surgery ; Monitoring, Intraoperative ; methods ; Retrospective Studies ; Robotics ; methods

PURPOSE: We determined factors associated with long-term outcomes of patients who underwent successful percutaneous mitral balloon valvuloplasty (PMV). MATERIALS AND METHODS: Between August 1980 and May 2013, 1187 patients underwent PMV at Severance Hospital, Seoul, Korea. A total of 742 patients who underwent regular clinic visits for more than 10 years were retrospectively analyzed. The endpoints consisted of repeated PMV, mitral valve (MV) surgery, and cardiovascular-related death. RESULTS: The optimal result, defined as a post-PMV mitral valve area (MVA) >1.5 cm² and mitral regurgitation ≤Grade II, was obtained in 631 (85%) patients. Over a mean follow up duration of 214±50 months, 54 (7.3%) patients underwent repeat PMV, 4 (0.5%) underwent trido-PMV, and 248 (33.4%) underwent MV surgery. A total of 33 patients (4.4%) had stroke, and 35 (4.7%) patients died from cardiovascular-related reasons. In a multivariate analysis, echocardiographic score [p=0.003, hazard ratio=1.56, 95% confidence interval (CI): 1.01–2.41] and post-MVA cut-off (p < 0.001, relative risk=0.39, 95% CI: 0.37–0.69) were the only significant predictors of long-term clinical outcomes after adjusting for confounding variables. A post-MVA cut-off value of 1.76 cm² showed satisfactory predictive power for poor long-term clinical outcomes. CONCLUSION: In this long-term follow up study (up to 20 years), an echocardiographic score >8 and post-MVA ≤1.76 cm² were independent predictors of poor long-term clinical outcomes after PMV, including MV reintervention, stroke, and cardiovascular-related death.
Adult ; *Catheterization ; Echocardiography ; Female ; Follow-Up Studies ; Humans ; Kaplan-Meier Estimate ; Male ; Mitral Valve Stenosis/diagnostic imaging/*surgery ; Multivariate Analysis ; Proportional Hazards Models ; Republic of Korea ; Time Factors ; Treatment Outcome