Usefulness of transesophageal three-dimensional echocardiography in the identification of individual segment/scallop prolapse of the mitral valve

We evaluated the potential usefulness of three-dimensional (3D) transesophageal echocardiography (TEE) in assessing individual scallop / segment prolapse in 36 adult patients with mitral valve prolapse (MVP) undergoing surgical correction. Intraoperative 3D TEE correctly identified the location of scallop / segment prolapse in 34 of 36 patients (94%). However, in 6 of these patients 3D TEE images revealed more scallops or segments with prolapse than the surgeon noted intraoperatively. Prolapse of these areas was less prominent and this could possibly explain the lack of correlation with the surgical findings in these patients. In another 2 patients areas of prolapse seen by the surgeon were missed by 3D TEE because some of those scallops Isegments could not be well imaged due to image "drop out" and artifacts. Thus, perfect correlation between 3D TEE and surgery was noted in 28 of 36 (78%) patients. Noncoaptation of the W was also identified in 2 patients. The prolapsed area of posterior (n = 28 observations) and anterior (n = 9 observations) W leaflets ranged from 1 cm 2 to 9 cm 2 (mean 3.50 cm(2) +/- 2.14) and 1.20 cm(2) to 5.99 cm(2) (mean 3.21 cm(2) +/- 1.33), respectively. Interobserver and intraobserver agreement for location and area of MVP was excellent (r = 0.97 and r = 0.99, respectively; all P values are <0.0001). In conclusion, 3D TEE is useful in identifying the location of MVP It may also be potentially useful in assessing the extent of individual scallop / segment prolapse and identifying sites of MV noncoaptation. This information could aid the surgeon in deciding the extent of W resection.