Clinical utility of

pre-operative 3D TEE

in surgical planning in

patients with

Degenerative or

Myxomatous Mitral

valve disease: a randomized controlled trial

Jenny-Lynn V. Juhuri MD

Edwin S. Tucay MD

Philippine Heart Center

Manila, Philippines

Degenerative Mitral

valve (MV) disease is the

leading cause of mitral

regurgitation (MR) in

developed countries

Figure 63-29. Echocardiography. Braunwald’s Heart

Disease. 10th ed. Philadelphia, Saunders, 2015

Chronic severe MR due to

Mitral valve prolapse

(MVP) is a significant

cause of cardiovascular

morbidity and mortality

Figure 63-30. Echocardiography. Braunwald’s Heart

Disease. 10th ed. Philadelphia, Saunders, 2015

2D transthoracic

echocardiography

(TTE)

Most common imaging

modality used to assess

suspected MR

Transesophageal

echocardiography (TEE)

Imaging modality of

choice for MV

• 3D TEE offers great

anatomical visualization

of the MV apparatus

What is the Clinical

utility of 3D TEE?

>> As to what extent thediagnostic testing changeshealth outcomes relative tothe current best alternative,which may be anotherdiagnostic test or no test atall

Bossuyt PM, Reitsma JB, Linnet K, Moons KGM. Beyond

diagnostic accuracy: The clinical utility of diagnostic tests.

Clinical Chemistry 58:12 1626-1643 (2012)

MV repair vs.

MV replacement???

Inclusion criteria: At least 19 years old

Severe MR secondary to

degenerative or

myxomatous MV disease

For MV surgery

Exclusion criteria:Significant multivalvular

involvement

Other cardiac operation during

MV surgery

Urgent surgery

Suboptimal pre-operative 3D

TEE images

Difficulties encountered intra-

operatively

13

(54)%

11

(46%)

MV diseases

Flail MV MVP

85% with

torn chordae

66% had bileaflet

involvement

13 (54%)

11 (46%)

Subjects

2D TTE

2D TTE + 3D TEE

10

(42%)14

(58%)

MV surgery

MVR MV repair

64% had

3D TEE

60% had 2D

TTE only

2D TTE + 3D TEE2D TTE

0

4

8

12

16

20

24

Change in surgicalrecommendation

36.4%

MVR MV repairAnterior

MVP with

torn chordae

3D TEE &

eSie valve

analysis:

Anterior

leaflet

segment

length & area,

prolapsing

height,

prolapsing

volume

Bileaflet

MVP

3D TEE &

eSie valve

analysis:

Anterior

leaflet

segment

length &

area, annulus

diameter

MV repair MVR

Bileaflet

MVP

2D TTE:

Anterior MVP

3D TEE:

Bileaflet MVP

Intra-

operative

TEE: Bileaflet

MVP

Posterior

MVP

2D TTE:

Posterior

MVP

3D TEE:

Posterior

MVP

Surgical

inspection:

Thickened

MV with

calcifications

2D TTE + 3D TEE2D TTE

70%

80%

90%

100%

Therapeutic

confidence

96%

Limitations:

Small number of cases

3D TEE technique and

its complex analysis

Surgeon’s skill and

expertise

3D TEE

Offers change in surgical

recommendation for

severe MR secondary to

myxomatous or

degenerative MV disease

Provides greater operator

confidence for making

pre-operative surgical

recommendation