title: Implementation of real-time three-dimensional transesophageal echocardiography for mitral balloon valvuloplasty.
abstract: BACKGROUND
  Transthoracic (TTE) and intracardiac echocardiography (ICE) have both been established as modalities for imaging guidance in mitral balloon valvuloplasty (MBV). Real-time three-dimensional transesophageal echocardiography (RT3D-TEE) improves depth resolution, characterization of pathology and visualization of interventional catheters and devices. Three-dimensional imaging should enhance catheter navigation but improvements in procedural outcomes are not easily quantified. Using time from transseptal puncture to balloon inflation, procedure time and radiation exposure as surrogates for improvements linked to image guidance, we describe our early experience in implementing RT3D-TEE during MBV, a prototypical left-sided structural intervention.
  
  
  METHODS
  Using a dedicated interventional procedures database, we reviewed the clinical and procedural variables of 70 consecutive cases of MBV utilizing either RT3D-TEE or TTE combined with ICE from 12/2004 to 4/2009.
  
  
  RESULTS
  The clinical characteristics of both groups were well matched and there was no difference in mean gradient reduction or complication rates. Fluoroscopy times (TTE/ICE 26.7 ± 5.6 min. vs. RT3D-TEE 23.3 ± 6 min. P = 0.02) and radiation dose-area product (TTE/ICE 216.2 ± 96.6 vs. RT3D-TEE 171.5 ± 63.9) were lower with the RT3D-TEE cohort. Time from 1st transseptal puncture attempt to 1st balloon inflation was found to be lower in the RT-3DTEE cohort (TTE/ICE 36 ± 8 min vs. 28 ± 8 min P <0.01) CONCLUSION: RT3D-TEE is associated with expedited transseptal puncture and balloon catheter navigation as reflected in the decreased transseptal to balloon time. RT3D-TEE is associated with less reliance on fluoroscopic navigation as compared to using TTE/ICE. This series demonstrates the feasibility and advantages of implementing RT3D-TEE for MBV.
authors.affiliation: Department of Medicine, Division of Cardiology, University of Texas Health Sciences Center, San Antonio, Texas.
authors.forename: Marvin H
authors.initials: MH
authors.lastname: Eng
authors.forename: Ernesto E
authors.initials: EE
authors.lastname: Salcedo
authors.forename: Michael
authors.initials: M
authors.lastname: Kim
authors.forename: Robert A
authors.initials: RA
authors.lastname: Quaife
authors.forename: John D
authors.initials: JD
authors.lastname: Carroll
mesh_terms: D000328:Adult; D000368:Aged; D063126:Balloon Valvuloplasty; D019560:Echocardiography, Three-Dimensional; D017548:Echocardiography, Transesophageal; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D011677:Punctures; D011829:Radiation Dosage; D015641:Radiography, Interventional / Q000379:methods; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
keywords: intracardiac echo; transeptal cath; valvular heart disease