title: Dynamic indices of mitral valve function using perioperative three-dimensional transesophageal echocardiography.
abstract: OBJECTIVE
  Perioperative transesophageal echocardiography is essential for decision-making for mitral valve surgery. While two-dimensional transesophageal echocardiography represents the standard of care, tracking of dynamic changes using three-dimensional imaging permits assessment of morphologic and functional characteristics of the mitral valve. The authors hypothesized that quantitative three-dimensional analysis would reveal distinct differences among diseased, repaired, and normal mitral valves.
  
  
  METHODS
  Case-control observational clinical study.
  
  
  METHODS
  Tertiary care hospital.
  
  
  METHODS
  Using novel mitral valve quantification software, the authors retrospectively analyzed 80 datasets of cardiac surgery patients who underwent intraoperative transesophageal echocardiographic imaging. Twenty patients with degenerative mitral regurgitation were evaluated before and after mitral valve repair. Twenty patients had functional mitral regurgitation, and 20 patients had no mitral valve disease.
  
  
  RESULTS
  Primary outcome measures of dynamic mitral valve function were: 1) three-dimensional annulus area, 2) annular displacement distance, 3) annular displacement velocity, and 4) annular area fraction. Other mitral annular tracking indices, in addition to intraobserver reliability and interobserver agreement, also were reported. Annulus area was enlarged in degenerative and functional mitral regurgitation. Annular displacement distance was decreased in functional mitral regurgitation and repaired valves. Annular displacement velocity was decreased in functional mitral regurgitation. Annular area fraction was decreased in functional mitral regurgitation and repaired valves. Intraobserver reliability and interobserver agreement were high for all 4 analyzed indices.
  
  
  CONCLUSIONS
  Normal, functional regurgitant, degenerative, and repaired mitral valves have distinctly different dynamic signatures of anatomy and function as reliably determined by perioperative echocardiographic tracking.
authors.affiliation: Department of Anesthesiology, Division of Cardiothoracic Anesthesiology and Critical Care Medicine, Duke University Medical Center, Durham, NC.
authors.forename: Karsten
authors.initials: K
authors.lastname: Bartels
authors.affiliation: Department of Anesthesiology, Division of Cardiothoracic Anesthesiology and Critical Care Medicine, Duke University Medical Center, Durham, NC; Department of Anesthesiology, University of Virginia School of Medicine, Charlottesville, VA.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Thiele
authors.affiliation: Department of Anesthesiology, Division of Cardiothoracic Anesthesiology and Critical Care Medicine, Duke University Medical Center, Durham, NC.
authors.forename: Barbara
authors.initials: B
authors.lastname: Phillips-Bute
authors.affiliation: Department of Surgery, Division of Cardiovascular and Thoracic Surgery.
authors.forename: Donald D
authors.initials: DD
authors.lastname: Glower
authors.affiliation: Department of Anesthesiology, Division of Cardiothoracic Anesthesiology and Critical Care Medicine, Duke University Medical Center, Durham, NC.
authors.forename: Madhav
authors.initials: M
authors.lastname: Swaminathan
authors.affiliation: Medicine, Division of Cardiology, Duke University Medical Center, Durham, NC.
authors.forename: Joseph
authors.initials: J
authors.lastname: Kisslo
authors.affiliation: Department of Anesthesiology and Pain Medicine, Division of Cardiothoracic Anesthesiology, University of Washington, Seattle, WA. Electronic address: gbmac@uw.edu.
authors.forename: G
authors.initials: G
authors.lastname: Burkhard Mackensen
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D017548:Echocardiography, Transesophageal / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging*; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging* / Q000503:physiopathology; D019990:Perioperative Care
keywords: 2D TEE; 3D TEE; computer applications; dynamic indices; echocardiography; mitral valve; perioperative; ultrasound