Der chirurgische Blick auf die Mitralklappe : Nutzen und Limitation der 3D Echokardiographie am Beispiel des Mitralklappenprolaps

Introduction: Recent advances in echocardiography may improve our ability to visualize the heart as a three-dimensional object. The 3D echocardiography (3DE) has the advantage of providing a rapid visual appreciation of spatial relationships that can potentially improve the accuracy and rapidity of assessment as well as the communication of finding to the other physicians and to patients. Purpose: The aim of this study was to validate the spatial resolution of 3DE datasets as well as the precision of measurements. Additionally, using an in vitro mitral valve prolaps (MVP) model and patients with similar valvular heart disease, the benefits of a 3D visualization in comparison to standard 2D methods were evaluated. Method: To generate tomographic image planes and 3D surfaces 2D ultrasound images were sequentially acquired and reconstructed, a method widespread used in 3DE. Results: The spatial resolution of 3D reconstructed image planes in this study agreed well with corresponding data in literature. For both the reconstructed image planes and the standard 2D echocardiography a maximal axial resolution of 0.6 mm and a lateral resolution of 1.1 mm were determined. Furthermore 3DE measurements of membrane defects (r=0.99, SEE 0.54 cm, p>0.05) and surfaces with irregular shape (r=0.99, SEE 4.69 mm², p>0.05) showed a significant correlation between actual and measured dimensions. In comparison 3DE surface reconstructions showed an overall reduced spatial resolution and tend to underestimate membrane defects (mean error: -151.14 mm²) significantly. Despite of this limitation the MVP model (17 excised calf hearts with surgically produced mitral valve prolaps) showed excellent agreement between 3DE and actual values (%mitral valve area involved by prolaps: r=0,93, SEE 3,9%, p>0,05; anterior: r=0.96, SEE 0.18 cm², p>0,05, posterior: r=0.97, SEE 0.2 cm², p>0.05, and prolaps area: r=0.93, SEE 0.14 cm², p>0.05). In 16 patients with mitral valve prolapse 3DE permitted rapid evaluation of segmental anatomy compared with the 2D mental reconstruction (mean of 61 sec vs. 295 sec). Segmental scoring of bulging (prolapse and flail) by 3DE agreed more often with the surgical map than the 2D-derived scores (89% vs. 69% agreement, p > 0.05). Observer concordance was considerately higher for the 3D vs. the 2D approach (Kappa: 0.57 ± 0.09 vs. 0.72 ± 0.07, p>0.05). Conclusion: 3DE allows anatomic localization of prolapsing leaflet segments with greater accuracy, reliability and rapidity than the conventional 2DE approach. Despite a lower spatial resolution in comparison to conventional 2D echocardiography 3DE provide accurate quantification of prolapsing leaflet segments in a projected surgical view that can be of value in planning surgical mitral valve repair.

Grantor dc:publisher

Publikationsserver der RWTH Aachen University

Year dc:date

2004

Author dc:creator

• Jansen, Christian Heinrich Paul

Contributors dc:contributor

• Rouvé, Gerhard

• info:eu-repo/classification/ddc/610
• Medizin
• Kardiologie
• Echokardiographie
• 3D

Statement dc:rights

• info:eu-repo/semantics/openAccess

Language dc:language

ger

Identifier

https://publications.rwth-aachen.de/search?p=id:%22RWTH-CONV-123588%22

OAI identifier oai:identifier

oai:publications.rwth-aachen.de:61987