Objective; We used the intraoperative transesophageal echocardiography in mitral valve repair surgery, and compared both echocardiographic modes (Eco2D versus Eco3D) in order to assess whether Eco3D is superior to Eco2D, for detection and accuracy of location of valve prolapse, chordal rupture (flail) and cleft. Methods; 90 patients have undergone repair surgery of mitral valve as a single or associated procedure were studied prospectively. The valve was inspected by surgeons and theirs findings were considered the "gold standard" and thus determined the accuracy. For each patient a comprehensive intraoperative transesophageal study was performed using a 3D probe, a complete and detailed, two-dimensional and three-dimensional echocardiography study were performed and all pictures were recorded. Results; Surgical inspection detected the presence of prolapse in 72 of the 90 valves inspected. In 18 patients no presence of prolapsed was found as a cause of valvular insufficiency. The presence or absence of mitral valve prolapsed was diagnosed correctly in 81 cases with an accuracy of 90% when Eco3D was used and in 71 cases Eco2D when applied with an accuracy of 78. 89%. The Eco3D correlated more strongly with surgical findings than Eco2D (difference of proportions = 11,1%; IC [1,56%, 22,18%], p=0,042). Furthermore, when the different scallops of the valve were analysed, the Eco3D was significantly better for detecting prolapses in the scallops A2 (difference in proportions = 10. 0%, CI [3. 43%, 18. 36%], p = 0. 012), A3 (difference in proportions = 7. 78%, CI [1,59%, 16,67%], p =0. 039), P1 (difference in proportions = 8. 36%, CI [4. 35%, 19. 67%], p = 0. 006), and P2 (difference in proportions = 14. 45% CI [7. 12% 23. 54%], p = 0. 0010). Surgical inspection also identified 53 and 37 patients with and without chordal rupture, respectively. Eco3D correctly diagnosed the presence or absence of chordal rupture in 85 of these patients (94. 44%) as opposed to 43 patients (71. 11% ) using Eco2D (difference in proportions = 23. 33% CI [13. 85%, 33. 71%], p 0. 001). The analysis by scallop showed that the accuracy of Eco3D was significantly higher for the most frequent lesions; scallop A2 (difference in proportions = 10. 0% CI [2. 85% 10. 86%], p = 0. 004), scallop P1 (difference in proportions = 8,8 %, CI [1,58%, 17. 46%], p =0. 039), and scallop P2 (difference in proportions = 19,89 %, CI [10,87 %, 28. 54%], p = 0. 0001). Conclusion: Although Eco2D remains the standard tool as intraoperative imaging for studying mitral valve, the Eco3D improves visualization of the valve pathology and increases the accuracy of the interpretation facilitated by the spatial orientation that allows the three-dimensional image mode.
| Date of Award | 10 Feb 2016 |
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| Original language | Spanish |
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| Awarding Institution | - Vall d'Hebron University Hospital (HUVH)
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| Supervisor | Río Jorge Aguilar Torres (Director), Jaume Roige Solé (Director) & Manuel Armengol Carrasco (Director) |
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