Live/Real Time Three-Dimensional Transthoracic Echocardiographic Assessment of Bicuspid Aortic Valve Morphology

We describe the usefulness of three-dimensional transthoracic echocardiography (3D TTE) in the assessment of bicuspid aortic valve morphology in an adult patient with no stenosis but severe aortic regurgitation .     

Live/Real Time Three-Dimensional Transesophageal Echocardiographic Evaluation of Mitral and Aortic Valve Prosthetic Paravalvular Regurgitation

Thirteen patients already scheduled for surgery for repair of prosthetic paravalvular regurgitation underwent intraoperative real time two-dimensional transesophageal echocardiography (2D TEE) and live/real time three-dimensional transesophageal echocardiography (3D TEE). In all patients, 3D TEE was able to provide more information regarding the location and size of the paravalvular defect as compared to 2D TEE. 3D TEE resulted in a more accurate localization of the defect and an estimation of the size of the defect that correlated much more closely with surgical findings when compared with 2D TEE. Our preliminary results demonstrate the superiority of 3D TEE over 2D TEE in the evaluation of paravalvular prosthetic regurgitation. 3D TEE not only provides an accurate assessment of the exact site of the leakage, but also gives a more accurate estimate of its size. This information could be valuable to surgeons who may encounter difficulty when localizing and estimating the size of paraprosthetic leaks while the heart is devoid of blood during surgery.     

Evaluation of a Posterior Mitral Valve Leaflet Aneurysm by Real Time Three-Dimensional Transesophageal Echocardiography

Posterior mitral valve (MV) leaflet aneurysms are extremely rare complications of infective endocarditis (IE). When MV aneurysms occur, they usually involve the anterior leaflet. Real time three-dimensional transesophageal echocardiography (RT3D TEE) has been recently developed and provides views of unparalleled quality by optimizing visualization of spatial relationships. We present a rare case of a posterior MV leaflet aneurysm due to IE in a 64-year-old woman, best visualized by RT3D TEE.     

Three-Dimensional Echocardiographic Assessment of Aortic Dissection

In the present study, we report our experience of using three-dimensional reconstruction of transesophageal two-dimensional echocardiographic images in the assessment of aortic dissection (22 patients), aortic rupture (1 patient), aortic aneurysm without dissection (2 patients), and aortic tumor (1 patient).     

Echocardiographic Detection of Two Distinct Left Ventricular Pseudoaneurysms After Mitral Valve Replacement

Left ventricular pseudoaneurysm after mitral valve replacement (MVR) is a rare but clinically significant complication. We report a case of two distinct left ventricular pseudoaneurysms after re-MVR, which was correctly diagnosed by two-dimensional echocardiography, and subsequently confirmed by surgery.     

Three-Dimensional Echocardiography of the Aortic Valve: Feasibility, Clinical Potential, and Limitations

Objectives: The purpose of our study was to assess the feasibility and potential clinical utility of three-dimensional echocardiography for evaluation of the aortic valve. Background: The value of three-dimensional echocardiographic assessment of the aortic valve has not been established yet. Methods: The study group comprised 32 patients (11 women, 21 men), mean age 56.1 (range 20–82). Seven morphologically normal valves, 5 homografts, 6 mechanical prostheses, and 14 valves of abnormal morphology were evaluated. Images were acquired during a routine multiplane transesophageal echocardiographic examination (rotational scan with 2° interval, respiration, and electrocardiogram [ECG] gating) and postprocessed off-line. A selection of reconstructed cutplanes (anyplane mode) and volume-rendered three-dimensional views of aortic valve anatomy were analyzed by two observers and compared with two-dimensional echocardiography findings. Results: The quality of reconstructions was scored excellent when permitting unrestricted assessment of aortic valve anatomy with optimized planimetric measurements (19 patients, 59%), adequate when aortic valve was partially visualized (7 patients, 22%), or inadequate when no assessment was possible (6 patients, 19%, including 5 with prosthetic valves). Three-dimensional echocardiography provided additional information in ten (31%) patients as compared with the two-dimensional echocardiographic findings. Conclusions. It can be concluded that three-dimensional echocardiographic reconstruction of the aortic valve is feasible, with excellent or adequate quality in 81% of patients, more frequently in native than in prosthetic valves, P < 0.05. Morphologic information additional to that provided by two-dimensional echocardiography is obtained in a significant proportion of patients.     

Three-Dimensional Echocardiographic Assessment of Lambl's Excrescences on the Aortic Valve

The present case reports demonstrate the incremental value of three-dimensional echocardiography over multiplane transesophageal two-dimensional imaging in the assessment of Lambl's excrescences (strands) involving the aortic valve.     

Rare Mycotic Aneurysm of the Mitral Valve without Aortic Valve Involvement

Mycotic aneurysms can be a rare, but serious complication of infectious endocarditis. We report the case of a 20‐year‐old woman who presented with fever and malaise from streptococcal bacteremia and found to have vegetation on the anterior leaflet of the mitral valve. On follow‐up visit, the patient was noted to have a mycotic aneurysm of the anterior mitral valve without aortic involvement. Her clinical course was complicated by mitral valve chordal rupture, severe mitral regurgitation, and dyspnea from severe mitral regurgitation for which she underwent successful surgical repair of the mitral valve.     

Concomitant Gerbode‐Like Defect and Anterior Mitral Leaflet Perforation after Aortic Valve Replacement for Endocarditis

We present a case of concomitant left ventricle (LV) to right atrial shunt (Gerbode‐like defect) and anterior mitral leaflet perforation in a 32‐year‐old male after aortic valve replacement for infective endocarditis of bicuspid aortic valve. This case emphasises that intra‐operative transesophageal echocardiography is a sine qua non for valvular surgical procedures.     

Impact of TAVI on Mitral Regurgitation: A Prospective Echocardiographic Study

Objective: This study aims to assess changes in mitral regurgitation (MR) severity after transcatheter aortic valve implantation (TAVI). Background: Existing data on MR after TAVI are contradictory. Methods: Thirty‐five patients with MR graded ≥ 2+ were followed after undergoing TAVI with either the Edwards Sapien or CoreValve device. Echocardiography was performed the week before and 3 months after the procedure. MR was graded on a scale of 0 to 4+, classified as organic or functional, and the effective regurgitant orifice area (EROA) and MR index were calculated. Results: At baseline, MR was graded 4+ in 4 (11.4%) patients, 3+  in 10 (28.6%), and 2+ in 21 (60%). At follow‐up, MR was graded at 3+ in 4 (11.4%) patients, 2+ in 8 (22.9%), and 1+ in 19 (54.3%); 4 (11.4%) exhibited no MR. EROA (24.4 ± 11.5 mm² pre‐TAVI vs. 11.2 ± 10.3 mm² post‐TAVI, P < 0.001) and MR index (1.9 ± 0.3 pre‐TAVI vs. 1.3 ± 0.7 post‐TAVI, P < 0.001) were reduced with TAVI, independent of the etiology. MR decreased by at least 1 grade in 28 (80%) patients, with a reduction ≥2 grades in 10 (28.6%) patients; no patient showed a worsened condition. Subgroup analyses showed that the reduction in MR was significant in patients treated with the Edwards Sapien device but not in patients treated with the CoreValve device. Conclusions: This multiparametric echocardiographic evaluation showed that MR improved significantly after TAVI and that this result may be related to the type of valve implanted.     

Visualization of Mitral Valve Tunnel Aneurysm by Transesophageal Echocardiography

We report the echocardiographic findings in a patient with a mitral valve aneurysm, probably occurring as a complication of aortic valve endocarditis. Transesophageal echocardiography showed a tunnel-shaped aneurysm of the atrial side of the anterior mitral leaflet, expanding in systole and collapsing in diastole. Transesophageal echocardiography is a useful diagnostic tool for the evaluation of mitral valve pathology.     

Relationship between Cutoff Values of Peak Aortic Valve Velocity and Those of Other Doppler Echocardiographic Parameters of Severity in Patients with Aortic Stenosis and Normal Flow

Background: Previous studies have reported inconsistencies between echocardiographic parameters of severity in aortic valve stenosis (AS). Peak aortic valve velocity (V_max) strongly predicts outcome in AS patients. This study was therefore designed to identify the cutoff values of echocardiographic parameters of severity corresponding to a V_max ≥ 3 m/sec, ≥4 m/sec, 5 m/sec, or 5.50 m/sec in a large cohort of patients with normal flow (NF) AS. Methods and Results: We retrospectively reviewed the echocardiograms of 528 consecutive patients with normal flow (NF) AS, left ventricular (LV) ejection fraction ≥0.50, and NF (stroke volume index > 35 mL/m²). The values of mean pressure gradient (MPG), aortic valve area (AVA), and indexed aortic valve area (IAVA) corresponding to V_max ≥ 3 m/sec obtained from receiver operating characteristic (ROC) curves analysis were 22 mmHg, 1.15 cm², and 0.60 cm²/m², respectively. While a cutoff of V_max ≥ 4 m/sec to define severe AS was consistent with a value of 39 mmHg for MPG, corresponding values for AVA and IAVA of 0.90 cm² and 0.48 cm²/m², respectively, were substantially different from those recommended in current guidelines. MPG ≥60 and 65 mmHg, AVA ≤0.76 and ≤0.68 cm², and IAVA ≤0.41 and ≤0.35 cm²/m² were related to a V_max ≥5 and ≥5.5 m/sec (very severe AS), respectively. Conclusions: Guidelines recommended cutoff values for AVA and IAVA are not consistent with those of V_max and MPG. The results of this study may serve as safeguard in case of apparent inconsistencies between echocardiographic parameters of severity in NF AS.