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• W2041194368 abstract "HomeCirculation: Cardiovascular ImagingVol. 1, No. 3Three-Dimensional Transesophageal Echocardiography in a Patient With Early Failure of Mitral Valve Repair Free AccessResearch ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplemental MaterialFree AccessResearch ArticlePDF/EPUBThree-Dimensional Transesophageal Echocardiography in a Patient With Early Failure of Mitral Valve RepairWhy Are We Still Looking at a Three-Dimensional Structure in 2 Dimensions? Martin J. Swaans, Richard L. Braam, Robin H. Heijmen, Herbert W.M. Plokker and Wybren Jaarsma Martin J. SwaansMartin J. Swaans From the Departments of Cardiology (M.J.S., R.L.B., H.W.M.P., W.J.) and Cardiothoracic Surgery (R.H.H.), St Antonius Hospital, Nieuwegein, The Netherlands. Search for more papers by this author , Richard L. BraamRichard L. Braam From the Departments of Cardiology (M.J.S., R.L.B., H.W.M.P., W.J.) and Cardiothoracic Surgery (R.H.H.), St Antonius Hospital, Nieuwegein, The Netherlands. Search for more papers by this author , Robin H. HeijmenRobin H. Heijmen From the Departments of Cardiology (M.J.S., R.L.B., H.W.M.P., W.J.) and Cardiothoracic Surgery (R.H.H.), St Antonius Hospital, Nieuwegein, The Netherlands. Search for more papers by this author , Herbert W.M. PlokkerHerbert W.M. Plokker From the Departments of Cardiology (M.J.S., R.L.B., H.W.M.P., W.J.) and Cardiothoracic Surgery (R.H.H.), St Antonius Hospital, Nieuwegein, The Netherlands. Search for more papers by this author and Wybren JaarsmaWybren Jaarsma From the Departments of Cardiology (M.J.S., R.L.B., H.W.M.P., W.J.) and Cardiothoracic Surgery (R.H.H.), St Antonius Hospital, Nieuwegein, The Netherlands. Search for more papers by this author Originally published1 Nov 2008https://doi.org/10.1161/CIRCIMAGING.108.793356Circulation: Cardiovascular Imaging. 2008;1:282–283A 47-year-old man was admitted with a massive inferolateral wall infarction due to proximal circumflex artery obstruction. After emergent percutaneous coronary intervention, the patient remained hemodynamically unstable because of severe mitral valve insufficiency due to massive annular dilatation combined with diffuse 3-vessel coronary disease and poor left ventricular function. Mitral valve annuloplasty and concomitant coronary bypass grafting were performed with good recovery initially. On the ward, the patient became progressively dyspnoeic with a new systolic apical murmur. Because of inadequate transthoracic acoustic windows, transesophageal echocardiography (TEE) was performed.Two-dimensional TEE showed severe mitral valve regurgitation. Posterior dehiscence of the annuloplasty ring was suggested (Figure 1A and 1B). Three-dimensional TEE images (3D transesophageal Philips probe, transducer X7-2t) provided a comprehensive anatomic overview almost undisputedly confirming our suspicion of annuloplasty ring dehiscence (Movie I; Figure 2). The patient was scheduled for early reoperation. Operative findings correlated fully with the preoperative 3D images (Figure 3). Because of the massively dilated posterior annulus, rerepair was not attempted and mitral valve replacement was performed with uneventful recovery. Download figureDownload PowerPointFigure 1. A, Two-dimensional TEE (0�) suggesting partial dehiscence of the mitral valve annuloplasty ring (red arrow). B, With color Doppler flow, severe mitral regurgitation with an excentric jet is shown.Download figureDownload PowerPointFigure 2. A, Peroperative photograph confirming partial dehiscence of the mitral valve annuloplasty ring. Similarity to the preoperative 3D images is excellent (B; Movie 1). Notice the torn stitches that are still connected to the annuloplasty ring. These are also visible on the 3D images (red arrows).In contrast to late failure of mitral valve repair, which is valve related in most cases, early recurrent mitral regurgitation is usually procedure related, with suture dehiscence as the predominant cause.1 It may result in dehiscence of commissural repairs or ring annuloplasty, as demonstrated in our case.2Three-dimensional echocardiography can provide detailed anatomic information additional to standard 2D TEE.3,4 It is conceivable that 3D TEE will evolve to become a cornerstone in the management of patients with valvular heart disease, especially mitral valve disease.The online-only Data Supplement is available at http://circimaging.ahajournals.org/cgi/content/full/1/3/282/DC1.DisclosuresNone.FootnotesCorrespondence to Martin J. Swaans, Koekoekslaan 1, 3435 CM Nieuwegein, The Netherlands. E-mail [email protected]References1 Dumont E, Gillinov AM, Blackstone EH, Sabik JF III, Svensson LG, Mihaljevic T, Houghtaling PL, Lytle BW. Reoperation after mitral valve repair for degenerative disease. Ann Thorac Surg. 2007; 84: 444–450.CrossrefMedlineGoogle Scholar2 Cerfolio RJ, Orzulak TA, Pluth JR, Harmsen WS, Schaff HV. Reoperation after valve repair for mitral regurgitation: early and intermediate results. J Thorac Cardiovasc Surg. 1996; 111: 1177–1183.CrossrefMedlineGoogle Scholar3 O'Gara P, Sugeng L, Lang R, Sarano M, Hung J, Raman S, Fischer G, Carabello B, Adams D, Vannan M. The role of imaging in chronic degenerative mitral regurgitation. J Am Coll Cardiol Cardiovasc Img. 2008; 1: 221–237.CrossrefGoogle Scholar4 García-Orta R, Moreno E, Vidal M, Ruiz-Lopéz F, Oyonarte JM, Lara J, Moreno T, García-Fernándezd MA, Azpitarte J. Three-dimensional versus two-dimensional transesophageal echocardiography in mitral valve repair. J Am Soc Echocardiogr. 2007; 20: 4–12.CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Agrawal R, Mukherjee S, Lee C, Chakraborty A and Lodha M (2022) Point-of-Care Ultrasound of the Heart: Transthoracic Echocardiogram A Practical Guide to Point of Care Ultrasound (POCUS), 10.1007/978-981-16-7687-1_5, (103-119), . Bonello B, Kostolny M and Marek J (2021) Enhanced Echocardiography Imaging in Reoperation for Complex Congenital Heart Disease in a Child, CASE, 10.1016/j.case.2020.11.002, 5:1, (81-85), Online publication date: 1-Feb-2021. Grapsa J, Zimbarra Cabrita I, Jakaj G, Ntalarizou E, Serapheim A, Demir O, Smith B, Dawson D, Momin A, Punjabi P, Anagnostopoulos C and Nihoyannopoulos P (2014) Strain balance of papillary muscles as a prerequisite for successful mitral valve repair in patients with mitral valve prolapse due to fibroelastic deficiency, European Heart Journal - Cardiovascular Imaging, 10.1093/ehjci/jeu163, 16:1, (53-61), Online publication date: 1-Jan-2015. Ciobanu A, Griffin S, Bennett S and Vinereanu D (2013) Catastrophic mitral prosthesis dehiscence diagnosed by three-dimensional transesophageal echocardiography, Journal of Clinical Ultrasound, 10.1002/jcu.22079, 42:4, (249-251), Online publication date: 1-May-2014. November 2008Vol 1, Issue 3 Advertisement Article InformationMetrics https://doi.org/10.1161/CIRCIMAGING.108.793356PMID: 19808552 Originally publishedNovember 1, 2008 PDF download Advertisement SubjectsCongenital Heart DiseaseEpidemiologyHeart Failure" @default.
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