title: Usefulness of intraoperative real-time three-dimensional transesophageal echocardiography for pre-procedural evaluation of mitral valve cleft: a case report.
abstract: A precise pre-procedural evaluation of mitral valve (MV) pathology is essential for planning the surgical strategy for severe mitral regurgitation (MR) and preparing for the intraoperative procedure. In the present case, a 38-year-old woman was scheduled to undergo MV replacement due to severe MR. She had a history of undergoing percutaneous balloon valvuloplasty due to rheumatic mitral stenosis during a previous pregnancy. A preoperative transthoracic echocardiography suggested a tear in the mid tip of the anterior mitral leaflet. However, the "en face" view of the MV in the left atrial perspective using intraoperative real time three-dimensional transesophageal echocardiography (RT 3D-TEE) provided a different diagnosis: a torn cleft in the P2-scallop of the posterior mitral leaflet (PML) with rupture of the chordae. Thus, surgical planning was changed intraoperatively to MV repair (MVRep) consisting of patch closure of the PML, commissurotomy, and lifting annuloplasty. The present case shows that intraoperative RT 3D-TEE provides more precise and reliable spatial information of MV for MVRep and facilitates critical surgical decision-making.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Uijongbu St. Mary's Hospital, The Catholic University of Korea, Uijeongbu, Korea.
authors.forename: Hyun Ju
authors.initials: HJ
authors.lastname: Jung
authors.affiliation: Department of Anesthesiology and Pain Medicine, Konkuk University Medical Center, Konkuk Universrity School of Medicine, Seoul, Korea.
authors.forename: Ga-Yon
authors.initials: GY
authors.lastname: Yu
authors.affiliation: Department of Anesthesiology and Pain Medicine, Konkuk University Medical Center, Konkuk Universrity School of Medicine, Seoul, Korea.
authors.forename: Jung-Ho
authors.initials: JH
authors.lastname: Seok
authors.affiliation: Department of Anesthesiology and Pain Medicine, Konkuk University Medical Center, Konkuk Universrity School of Medicine, Seoul, Korea.
authors.forename: Chungsik
authors.initials: C
authors.lastname: Oh
authors.affiliation: Department of Anesthesiology and Pain Medicine, Konkuk University Medical Center, Konkuk Universrity School of Medicine, Seoul, Korea.
authors.forename: Seong-Hyop
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Department of Anesthesiology and Pain Medicine, Konkuk University Medical Center, Konkuk Universrity School of Medicine, Seoul, Korea.
authors.forename: Tae-Gyoon
authors.initials: TG
authors.lastname: Yoon
authors.affiliation: Department of Anesthesiology and Pain Medicine, Konkuk University Medical Center, Konkuk Universrity School of Medicine, Seoul, Korea.
authors.forename: Tae-Yop
authors.initials: TY
authors.lastname: Kim
keywords: Mitral valve insufficiency; Transesophageal echocardiography