Mitral Valve Morphology Assessment: Three-Dimensional Transesophageal Echocardiography Versus Computed Tomography Miriam Shanks, MD, Victoria Delgado,

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Presentation transcript:

Mitral Valve Morphology Assessment: Three-Dimensional Transesophageal Echocardiography Versus Computed Tomography Miriam Shanks, MD, Victoria Delgado, MD, Arnold C.T. Ng, MBBS, Frank van der Kley, MD, Joanne D. Schuijf, PhD, Eric Boersma, PhD, Nico R.L. van de Veire, MD, PhD, Gaetano Nucifora, MD, Matteo Bertini, MD, Albert de Roos, MD, PhD, Lucia Kroft, MD, PhD, Martin J. Schalij, MD, PhD, Jeroen J. Bax, MD, PhD The Annals of Thoracic Surgery Volume 90, Issue 6, Pages 1922-1929 (December 2010) DOI: 10.1016/j.athoracsur.2010.06.116 Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Real time three-dimensional transesophageal echocardiography technique for assessment of mitral valve geometry. (A) Using the multiplanar reformation planes, the Mitral Valve Quantification software identifies the landmarks points of the mitral valve apparatus. The anterior, posterior, anterolateral, and posteromedial points of the mitral annulus are identified onto the two- and three-chamber views. The en face view provides the cross-sectional area of the mitral annulus, and simultaneously, the three-dimensional full volume of the mitral valve can be visualized. (B) The software generates a model of the mitral valve and the various measurements can be taken semiautomatically. (A = anterior; AL = anterolateral; Ao = aorta; LA = left atrium; LV = left ventricle; P = posterior; PM = posteromedial.) The Annals of Thoracic Surgery 2010 90, 1922-1929DOI: (10.1016/j.athoracsur.2010.06.116) Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Examples of the mitral valve geometry determinants obtained by multidetector row computed tomography. From the three-chamber views, the following measurements were obtained: (A) anterior mitral leaflet angle; (B) posterior leaflet angle; (C) mitral leaflet tenting height (arrow) and coaptation angle; and (D) aortomitral annulus angle. In addition, proper alignment of the multiplanar reformation planes along the mitral leaftlets permits visualization of (E) the sagittal view (three-chamber view) and (F) the short-axis view at the level of the posterior mitral leaflet. (G) The length of the posterior mitral leaflet can be measured, and (H) the posterior mitral leaflet area can be quantified by planimetry. (AML = anterior mitral leaflet; Ao = aorta; LA = left atrium; LV = left ventricle; PMLA = posterior mitral leaflet area; PMLL = posterior mitral leaflet length.) The Annals of Thoracic Surgery 2010 90, 1922-1929DOI: (10.1016/j.athoracsur.2010.06.116) Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Comparison between three-dimensional transesophageal echocardiography (3D TEE) and multidetector row computed tomography (MDCT) to measure the mitral valve annular geometry. Intraclass correlation (ICC) analysis and Bland-Altman plots demonstrating good agreement in the measurements of the mitral valve annular measurements (intercommissural and anteroposterior diameters and mitral valve annular area) were obtained using three-dimensional TEE and MDCT. (A) Intercommissural annular diameter. (B) Anteroposterior annular diameter. (C) Mitral annular area. The Annals of Thoracic Surgery 2010 90, 1922-1929DOI: (10.1016/j.athoracsur.2010.06.116) Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Comparison between three-dimensional transesophageal echocardiography (3D TEE) and multidetector row computed tomography (MDCT) to measure the mitral anterior leaflet geometry. Intraclass correlation (ICC) analysis and Bland-Altman plots demonstrating good agreement in the measurements of the length, area, and angle of the anterior mitral leaflet were obtained using three-dimensional TEE and MDCT. (A) Anterior leaflet length. (B) Anterior leaflet angle. (C) Anterior leaflet area. The Annals of Thoracic Surgery 2010 90, 1922-1929DOI: (10.1016/j.athoracsur.2010.06.116) Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Comparison between three-dimensional transesophageal echocardiography (3D TEE) and multidetector row computed tomography (MDCT) to measure the mitral posterior leaflet geometry. Intraclass correlation (ICC) analysis and Bland-Altman plots demonstrating good agreement in the measurements of the length, area, and angle of the posterior mitral leaflet were obtained using three-dimensional TEE and MDCT. (A) Posterior leaflet length. (B) Posterior leaflet angle. (C) Posterior leaflet area. The Annals of Thoracic Surgery 2010 90, 1922-1929DOI: (10.1016/j.athoracsur.2010.06.116) Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

Fig 6 Comparison between three-dimensional transesophageal echocardiography (3D TEE) and multidetector row computed tomography (MDCT) to measure the tenting height, leaflet coaptation, and aortomitral annular angle. Intraclass correlation (ICC) analysis and Bland-Altman plots demonstrate good agreement using three-dimensional TEE and MDCT. (A) Tenting height. (B) Leaflet coaptation angle. (C) Aortoannulus angle. The Annals of Thoracic Surgery 2010 90, 1922-1929DOI: (10.1016/j.athoracsur.2010.06.116) Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions