title: Quantification of mitral valve anatomy by three-dimensional transesophageal echocardiography in mitral valve prolapse predicts surgical anatomy and the complexity of mitral valve repair.
abstract: BACKGROUND
  Three-dimensional (3D) transesophageal echocardiography (TEE) is more accurate than two-dimensional (2D) TEE in the qualitative assessment of mitral valve (MV) prolapse (MVP). However, the accuracy of 3D TEE in quantifying MV anatomy is less well studied, and its clinical relevance for MV repair is unknown.
  
  
  METHODS
  The number of prolapsed segments, leaflet heights, and annular dimensions were assessed using 2D and 3D TEE and compared with surgical measurements in 50 patients (mean age, 61 ± 11 years) who underwent MV repair for mainly advanced MVP.
  
  
  RESULTS
  Three-dimensional TEE was more accurate (92%-100%) than 2D TEE (80%-96%) in identifying prolapsed segments. Three-dimensional TEE and intraoperative measurements of leaflet height did not differ significantly, while 2D TEE significantly overestimated the height of the posterior segment P1 and the anterior segment A2. Three-dimensional TEE quantitative MV measurements were related to surgical technique: patients with more complex MVP (one vs two to four vs five or more prolapsed segments) showed progressive enlargement of annular anteroposterior (31 ± 5 vs 34 ± 4 vs 37 ± 6 mm, respectively, P = .02) and commissural diameters (40 ± 6 vs 44 ± 5 vs 50 ± 10 mm, respectively, P = .04) and needed increasingly complex MV repair with larger annuloplasty bands (60 ± 13 vs 67 ± 9 vs 72 ± 10 mm, P = .02) and more neochordae (7 ± 3 vs 12 ± 5 vs 26 ± 6, P < .01).
  
  
  CONCLUSIONS
  Measurements of MV anatomy on 3D TEE are accurate compared with surgical measurements. Quantitative MV characteristics, as assessed by 3D TEE, determined the complexity of MV repair.
authors.affiliation: Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada. patric.biaggi@usz.ch
authors.forename: Patric
authors.initials: P
authors.lastname: Biaggi
authors.forename: Sean
authors.initials: S
authors.lastname: Jedrzkiewicz
authors.forename: Christiane
authors.initials: C
authors.lastname: Gruner
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Meineri
authors.forename: Jacek
authors.initials: J
authors.lastname: Karski
authors.forename: Annette
authors.initials: A
authors.lastname: Vegas
authors.forename: Felix C
authors.initials: FC
authors.lastname: Tanner
authors.forename: Harry
authors.initials: H
authors.lastname: Rakowski
authors.forename: Joan
authors.initials: J
authors.lastname: Ivanov
authors.forename: Tirone E
authors.initials: TE
authors.lastname: David
authors.forename: Anna
authors.initials: A
authors.lastname: Woo
mesh_terms: D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D017548:Echocardiography, Transesophageal / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058386:Mitral Valve Annuloplasty / Q000379:methods*; D008945:Mitral Valve Prolapse / Q000000981:diagnostic imaging* / Q000601:surgery*; D011379:Prognosis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D025321:Surgery, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome