• Sagit Ben Zekry, Sherif F Nagueh, Stephen H Little, Miguel A Quinones, Marti L McCulloch, Singh Karanbir, Elizabeth L Herrera, Gerald M Lawrie, and William A Zoghbi.
• Cardiovascular Imaging Institute, Echocardiography Laboratory, Cardiovascular Imaging Institute, Cardiovascular and Thoracic Surgery, Anesthesiology Department, The Methodist DeBakey Heart and Vascular Center, Houston, Texas 77030, USA.
• J Am Soc Echocardiogr. 2011 Oct 1;24(10):1079-85.

BackgroundIdentification of mitral regurgitation (MR) mechanism and pathology are crucial for surgical repair. The aim of the present investigation was to evaluate the comparative accuracy of real-time three-dimensional (3D) transesophageal echocardiography (TEE) and transthoracic echocardiography (TTE) with two-dimensional (2D) TEE and TTE in diagnosing the mechanism of MR compared with the surgical standard.MethodsForty patients referred for surgical mitral valve repair were studied; 2D and 3D echocardiography with both TTE and TEE were performed preoperatively. Two independent observers reviewed the studies for MR pathology, functional or organic. In organic disease, the presence and localization of leaflet prolapse and/or flail were noted. Surgical findings served as the gold standard.ResultsThere was 100% agreement in identifying functional versus organic MR among all four modalities. Overall, 2D TTE, 2D TEE, and 3D TEE performed similarly in identifying a prolapse or a flail leaflet; 3D TEE had the best agreement in identifying anterior leaflet prolapse, and it also showed an advantage for segmental analysis. Three-dimensional TTE was less sensitive and less accurate in identifying flail segments.ConclusionAll modalities were equally reliable in identifying functional MR. Both 2D TEE and 3D TEE were comparable in diagnosing MR mechanism, while 3D TEE had the advantage of better localizing the disease. With current technology, 3D TTE was the least reliable in identifying valve pathology.

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