JACC: 3D TEE acquires excellent heart images, may enjoy widespread adoption

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Although the 3D-matrix array transesophageal echocardiographic (3D-MTEE) probe allows excellent visualization of native mitral valve and other intracardiac structures, consistent optimal imaging of the aortic and tricuspid valves may require further technological advances, according to a study in the Aug. 5 issue of the Journal of the American College of Cardiology.

Lissa Sugeng, MD, from the departments of medicine, cardiac surgery, anesthesia and critical care at the University of Chicago, and colleagues said the goal of their study was to evaluate the 3D-MTEE probe by assessing the image quality of native valves and other intracardiac structures. Philips Healthcare of North Andover, Mass., developed the probe.

In 211 patients, the researchers obtained 3D-MTEE, zoom images of the mitral valve (MV) aortic valve (AV), tricuspid valve (TV), interatrial septum and left atrial appendage, followed by a left ventricular wide-angled acquisition. They reviewed images and graded off-line (Xcelera with QLAB software, Philips).

Sugeng and colleagues observed “excellent visualization of the MV (85 to 91 percent for all scallops of both MV leaflets), interatrial septum (84 percent), left atrial appendage (86 percent) and left ventricle (77 percent).” The investigators found that the native aortic and tricuspid valves were optimally visualized only in 18 percent and 11 percent of patients, respectively.

Because of the MV visualization, the “3D-MTEE imaging may become one of the modalities of choice to assess this valve during perioperative planning of MV surgery,” according to the authors. 

The researchers found that the “anterior cardiac structures, such as the AV and TV, were less well visualized because of leaflet dropout artifacts, which can probably be attributed to the longer distance between these structures and the transducer and to the oblique angle of incidence of the beam combined with the thinner leaflets in these valves.”

The authors concluded that the use of 3D-MTEE imaging, which is feasible in most patients, provides superb imaging of native MVs, which makes this modality an excellent choice for MV surgical planning and guidance of percutaneous interventions. The investigators noted that optimal aortic and tricuspid valve imaging will depend on further technological developments.

However, the researchers said that the “fast acquisition and immediate online display will facilitate wider acceptance and routine use in clinical practice.”

While Philips did not sponsor the study, Roberto M. Lang, MD, who was on the research team, is a member of the speakers' bureau for Philips Healthcare.