From the transducer to the scalpel: Anatomic correlation between echocardiographic images and surgery findings in native and prosthetic mitral pathology

pp. 448-453

Abstract

Assessing the anatomy and dynamics of the mitral valve (MV) is essential to the understanding of pathology
and planning of therapeutic interventions to improve patient morbidity and mortality. Transthoracic echocardiography (TTE) allows a thorough structural and functional assessment of the MV in real time, and thanks to its reproducibility, and near universal availability, it has become the primary modality employed for MV evaluation. Due to the tomographic nature of TTE, it is necessary to assess the MV in several transducer positions in order to perform a complete anatomical and functional evaluation. Advanced echocardiographic modalities, such as transesophageal (TEE), are often crucial to determine the etiology, mechanism and severity of mitral valve disease (MVD), as well as to decide the appropriate timing and method of intervention. (1) Moreover, guidelines
have proposed that further expansion of this technique would be useful to facilitate surgical decision-making.
(2)
The use of three-dimensional echocardiography (3DE) allows rotating and visualizing cardiac structures from any desired perspective, avoiding geometrical assumptions, and providing while providing information of both anatomy and function. (1)
A wide range of structural abnormalities and diverse etiologies can affect the MV. Due to the complex structure and physiology of the MV apparatus, identifying the mechanisms resulting in MV disease is often challenging. Although percutaneous procedures have been developed as an alternative therapy for selected patients with suitable anatomy, surgery remains the cornerstone therapy for native MVD and prosthetic-related complications. (3)

We hereby present a comprehensive case series of different etiologies of native MVD, as well as prosthetic pathology, in which we aim to depict the correlation between the clinical information provided by the different echocardiographic modalities and the anatomical findings seen in the operation room, thereby depicting a “fullpicture” of the pathology, from transducer to scalpel.