Three-dimensional versus two-dimensional transesophageal echocardiography in mitral valve repair

Objectives: We sought to compare the diagnostic performance of 3-dimensional (3D) versus 2-dimensional (2D) echocardiography in patients with regurgitant mitral valve. Background: An accurate assessment of morphology and function of the mitral valve is essential for surgical repair. Two-dimensional echocardiography has certain spatial limitations that could be overcome by 3D imaging. Methods. Preoperative transesophageal 2D and 3D studies were compared with surgical findings in patients undergoing surgical repair for severe mitral regurgitation. Results: A total of 81 consecutive patients underwent surgical repair (2002-2004). There was a high concordance (88%-100%) between both 2D and 3D studies and surgical findings in classification of involved segments. 3D imaging more accurately classified A1 segment defects (P = .05) and commissural dysfunction (P = .02). The 2D study incorrectly classified 22 segments, mainly corresponding to complex disease. The 3D study incorrectly classified 14 segments, unrelated to complex disease. Good agreement (94%, kappa 0.845) was found between nonexpert and expert interpretations of 3D images. Conclusions. Three-dimensional echocardiography offers high accuracy in mitral valve evaluation. It may complement 2D study in patients with complex valve anatomy, where surgical decisions are more difficult. The images can be easily interpreted by professionals without a high degree of experience.