title: Comparative accuracy of two- and three-dimensional transthoracic and transesophageal echocardiography in identifying mitral valve pathology in patients undergoing mitral valve repair: initial observations.
abstract: BACKGROUND
  Identification of mitral regurgitation (MR) mechanism and pathology are crucial for surgical repair. The aim of the present investigation was to evaluate the comparative accuracy of real-time three-dimensional (3D) transesophageal echocardiography (TEE) and transthoracic echocardiography (TTE) with two-dimensional (2D) TEE and TTE in diagnosing the mechanism of MR compared with the surgical standard.
  
  
  METHODS
  Forty patients referred for surgical mitral valve repair were studied; 2D and 3D echocardiography with both TTE and TEE were performed preoperatively. Two independent observers reviewed the studies for MR pathology, functional or organic. In organic disease, the presence and localization of leaflet prolapse and/or flail were noted. Surgical findings served as the gold standard.
  
  
  RESULTS
  There was 100% agreement in identifying functional versus organic MR among all four modalities. Overall, 2D TTE, 2D TEE, and 3D TEE performed similarly in identifying a prolapse or a flail leaflet; 3D TEE had the best agreement in identifying anterior leaflet prolapse, and it also showed an advantage for segmental analysis. Three-dimensional TTE was less sensitive and less accurate in identifying flail segments.
  
  
  CONCLUSIONS
  All modalities were equally reliable in identifying functional MR. Both 2D TEE and 3D TEE were comparable in diagnosing MR mechanism, while 3D TEE had the advantage of better localizing the disease. With current technology, 3D TTE was the least reliable in identifying valve pathology.
authors.affiliation: Cardiovascular Imaging Institute, Echocardiography Laboratory, Cardiovascular Imaging Institute, Cardiovascular and Thoracic Surgery, Anesthesiology Department, The Methodist DeBakey Heart and Vascular Center, Houston, Texas 77030, USA.
authors.forename: Sagit
authors.initials: S
authors.lastname: Ben Zekry
authors.forename: Sherif F
authors.initials: SF
authors.lastname: Nagueh
authors.forename: Stephen H
authors.initials: SH
authors.lastname: Little
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Quinones
authors.forename: Marti L
authors.initials: ML
authors.lastname: McCulloch
authors.forename: Singh
authors.initials: S
authors.lastname: Karanbir
authors.forename: Elizabeth L
authors.initials: EL
authors.lastname: Herrera
authors.forename: Gerald M
authors.initials: GM
authors.lastname: Lawrie
authors.forename: William A
authors.initials: WA
authors.lastname: Zoghbi
mesh_terms: D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D017548:Echocardiography, Transesophageal / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D008945:Mitral Valve Prolapse / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D011379:Prognosis; D011446:Prospective Studies; D015203:Reproducibility of Results