Accurate Localization of Mitral Regurgitant Defects Using Multiplane Transesophageal Echocardiography Gary P. Foster, Eric M. Isselbacher, Geoffrey A.

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Presentation transcript:

Accurate Localization of Mitral Regurgitant Defects Using Multiplane Transesophageal Echocardiography Gary P. Foster, Eric M. Isselbacher, Geoffrey A. Rose, David F. Torchiana, Cary W. Akins, Michael H. Picard The Annals of Thoracic Surgery Volume 65, Issue 4, Pages 1025-1031 (April 1998) DOI: 10.1016/S0003-4975(98)00084-8

Fig. 1 (A) Reference view displaying the mitral valve and its anatomic relationship to the aortic root (Ao) and the left atrial appendage (LAA) as seen from the left ventricular apex. (B) Reference view demonstrating the relationship of the transesophageal echocardiographic imaging planes to the mitral valve with the probe positioned in the standard midesophageal position. (C) Surgical view of the mitral valve as seen from left atrium with the heart rotated. See text for details. (A1, A2, A3 = anterior leaflet sections; P1, P2, P3 = posterior leaflet sections.) The Annals of Thoracic Surgery 1998 65, 1025-1031DOI: (10.1016/S0003-4975(98)00084-8)

Fig. 2 (A) Reference view displaying the prosthetic mitral valve and its anatomic relationship to the aortic root (Ao) and left atrial appendage (LAA) as seen from the left ventricular apex. The hours of a clock face, corresponding to those shown in the surgical perspective, have been overlaid. (B) Surgical view of prosthetic mitral valve and its relationship to the aortic root. The Annals of Thoracic Surgery 1998 65, 1025-1031DOI: (10.1016/S0003-4975(98)00084-8)

Fig. 3 (A) Effect of flexion or withdrawal and retroflexion or advancement of the transesophageal probe tip on the imaging plane in relation to the mitral valve at a transducer rotational angle of 0 degrees. (B) Effect of clockwise and counterclockwise probe rotation on the imaging plane in relation to the mitral valve with the transducer rotational angle adjusted to the major axis of the mitral orifice (typically 45 to 90 degrees). (Ao = aorta; A1, A2, A3 = anterior leaflet sections; LAA = left atrial appendage; P1, P2, P3 = posterior leaflet sections.) The Annals of Thoracic Surgery 1998 65, 1025-1031DOI: (10.1016/S0003-4975(98)00084-8)

Fig. 4 Example of a focal P1 prolapse identified at a transducer rotational angle of 0 degrees with the imaging plane through the aortic root (AR) and the anterolateral portion of the mitral leaflets. (LA = left atrium; LV = left ventricle; RV = right ventricle.) The Annals of Thoracic Surgery 1998 65, 1025-1031DOI: (10.1016/S0003-4975(98)00084-8)

Fig. 5 Example of a discrete paravalvular leak (PVL) at a transducer rotational angle of 0 degrees corresponding to a location of 7 o’clock on the surgical clock face. (BPMV = bioprosthetic mitral valve; LA = left atrium; LV = left ventricle.) The Annals of Thoracic Surgery 1998 65, 1025-1031DOI: (10.1016/S0003-4975(98)00084-8)