Impact of 3D echocardiography on mitral valve surgery

Clinical echocardiography began as a one-dimensional (1D) technique using initially the A-mode (Amplitude mode) and then the M-mode (time-motion mode) with dedicated investigators exploring the potential applications. The development of two-dimensional (2D) echocardiography expanded the applications and resulted in more widespread applications of the technique. In order to overcome the problem of examining three dimensional (3D) structures, such as the heart with its intricate anatomy, several windows for 2D imaging have been developed. This approach requires a mental reconstruction of the intracardiac anatomy based on multiple 2D imaging planes. A need to define the mitral valve anatomy as related to emerging valve repair techniques resulted in development of systematic transesophageal multiplane images . These have permitted accurate assessment of the valve pathology based on mental reconstruction of 3D anatomy with varying success . Even when successful, this approach does not lend itself to easy communication with the surgeon, depending on his/her familiarity with echocardiographic imaging planes. The advent of 3D echocardiography promises to permit more consistent and accurate evaluation of the valvular and other cardiac structures and provide for more effective communication between the echocardiographer and the surgeon.