Real time three-dimensional transesophageal echocardiography: a novel approach for the assessment of prosthetic heart valves.
OBJECTIVE
To explore our initial experience with real time three-dimensional transesophageal echocardiography (RT3DTEE) for the assessment of prosthetic valves (PV).


METHODS
The study included 40 patients (mean age 35 ± 8.5 years, 68% male) who underwent PV implant. Fifty PV (34 bioprosthetic and 16 mechanical) were evaluated using two-dimensional (2D)TEE and RT3DTEE to rule out PV dysfunction.


RESULTS
In all patients, RT3DTEE allowed good and simultaneous visualization of PV leaflets. Ten patients had normal functioning PV (5 in mitral, 3 in aortic, and 2 in tricuspid positions). Infective endocarditis was evident in 13 patients (20 PV) by repeated 2DTEE. RT3DTEE confirmed the 2DTEE diagnosis of endocarditis in same patients. Clear delineation of vegetations (size, site, and number) was obtained from RT3DTEE full volume while the vegetation attachment, consistency, mobility and its relation to valve structure were obtained using zoom 3D. Paraaortic abscesses size, site, extension, wall thickness of the abscess could be identified by RT3DTEE in 7 PV. Through cropping of the full-volume 3D images, the orifice of communication between the abscess cavity and aorta could be visualized well in en face view. Color full-volume allowed the detection of paravalvular regurgitation (size, location, direction, and extent) in 8 patients. In the 18 PV who underwent redo surgery, the intra-operative findings confirmed the RT3DTEE description of PV lesions.


CONCLUSIONS
Real time 3DTEE improved the anatomical and functional assessment of PV with better understanding of the underlying causes of PV dysfunction; hence, it could improve the management planning for such patients.
Department of Cardiology, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia; Department of Cardiology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
Ashraf M
AM
Anwar
Youssef F M
YF
Nosir
Mirvat
M
Alasnag
Hassan
H
Chamsi-Pasha
D000328:Adult; D001705:Bioprosthesis / Q000009:adverse effects*; D003199:Computer Systems; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D017548:Echocardiography, Transesophageal / Q000379:methods*; D019544:Equipment Failure Analysis / Q000379:methods; D005260:Female; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery*; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006801:Humans; D008297:Male; D011379:Prognosis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
prosthetic valve; real time three-dimensional echocardiography; transesophageal echocardiography