1. 3D Echocardiography

2. u 3D Transesophageal echocardiography has become practical for intraoperative use u Technology provides 3D visualization of MV and offers options for MV measurements. u 2010 meeting will have sessions discussing this technology

3. 3D Echo Case #1 Degenerative Mitral Valve Disease Myxomatous Degeneration

4. Mid-esophageal four-chamber TEE view with color flow doppler demonstrating billowing prolapse of both mitral leaflets and significant mitral regurgitation consistent with myxomatous degeneration.

6. Real-time, three-dimensional TEE (IE33; Matrix X7-2t; Philips Healthcare, Inc.) en- face view of the mitral valve from the left atrial perspective demonstrating billowing and diffuse prolapse of both mitral leaflets consistent with myxomatous degeneration.

8. Computer generated image of the mitral valve (Q-labs, Philips Heathcare, Inc) from the left atrial perspective demonstrating billowing and diffuse prolapse of both mitral leaflets consistent with myxomatous degeneration.

9. Real-time, three-dimensional TEE (IE33; Matrix X7-2t; Philips Healthcare, Inc.) en- face view of the mitral valve from the left atrial perspective in this patient with myxomatous degeneration following mitral valve repair with a posterior leaflet resection and partial ring annuloplasty.

11. 3D Echo Case #2 Functional Mitral Regurgitation

12. Mid-esophageal four-chamber TEE view with color flow doppler demonstrating apical tethering of both anterior and posterior leaflet with a severe, central jet of mitral regurgitation.

14. Zoom image of the mitral valve from a mid-esophageal four-chamber TEE imaging plane. Note the significant, bileaflet apical tethering which is typical in patients with functional mitral regurgitation.

16. Real-time, three-dimensional TEE (IE33; Matrix X7-2t; Philips Healthcare, Inc.) en-face view of the mitral valve from the left atrial perspective in this patient with functional mitral regurgitation.

18. Full volume, color flow Doppler, three-dimensional TEE (IE33; Matrix X7-2t; Philips Healthcare, Inc.) en-face view of the mitral valve from the left atrial perspective showing significant, central jet of mitral regurgitation.

20. Computer generated image (Q-labs, Philips Heathcare,Inc) showing significant apical tethering of posterior and anterior mitral valve leaflets with large tenting volume

21. Real-time, three-dimensional TEE (IE33; Matrix X7-2t; Philips Healthcare, Inc.) en-face view of the mitral valve from the left atrial perspective in this patient with functional mitral regurgitation following mitral valve repair with a full ring annuloplasty.

23. Additional 3D Echoes Following

24. MV Normal

25. MV P2 Flail Pre-op

26. MV P2 Prolapse

27. MV P3 Flail Pre-op

28. MV P3 Flail Post-op

29. Barlows

30. References u Grewel J, Miller FA, et al: Real-Time Three-Dimensional Transesophageal Echocardiography in the Intraoperative Assessment of Mitral Valve Disease. J Am Soc Echocardiogr 2009 Jan; 22(1):34-41. u Shernan SK: Intraoperative Three-Dimensional Echocardiography: Ready for Primetime? J Am Soc Echocardiogr 2009 Jan 22(1)27A-28A. u Salcedo EE, CarollJD, et al: A Framework fro Systemic Characterization of the Mitral Valve by Real-Time Three- Dimensional Transesophageal Echocardiography. J Am Soc Echocardiogr 2009 Oct; 22(10):10870-99