Prosthetic valve 3D and TEE new aspects

Real-time 3Dechocardiography, particularly during TEE, is suitable for the evaluation of prosthetic valves and provides incremental advantage over 2D imaging. The 3D ‘en-face’ surgical view of the valve is extremely helpful for determining prosthetic valve function and defining the presence, origin, direction, and extension of regurgitant jets. Leaks are defined by 3D echocardiography as echo dropout areas outside the sewing ring confirmed by color Doppler. 3D echocardiography allows advantageous visualization of prosthetic valves components such as the leaflets, rings, and struts (leaflets or disc material support), irrespective of the position. The presence and localization of thrombus formation, pannus, and prosthetic valve dehiscence can be evaluated by 3D echocardiography. This is especially useful for the assessment of mechanical mitral and aortic valves where 2D images are often of poor quality due to acoustic shadowing. With 3D imaging, the ventricular side of mitral prosthetic valves, which is consistently prevented with 2D imaging, can be often visualized. After locating the best plane for imaging by standard 2D images, narrow-angled acquisition mode, and 3D zoom mode, full-volume acquisition (single or multi-beat with ECG gating) with and without color Doppler can be performed. Once the 3D data sets are acquired, they can be cropped to optimally visualize cardiac structures. There are a few limitations to 3D imaging such as poor visualization of anterior cardiac structures, poor temporal resolution, suboptimal images due to poor ECG triggering in patients with arrhythmias, and tissue dropout.