Background Real-time three dimensional transoesophageal echocardiography (RT 3D-TEE) may better reflect left ventricle (LV) shape and function than cconventional 2D-TEE. The goal of this study was to evaluate the advantages of 3D analysis in shape assessment and to quantify the LV volume by ejection fraction (EF) measurement, after LV surgical remodelling.

Methods In a prospective manner, twenty consecutive coronary surgery patients with LV anteroapical aneurysm and functional mitral regurgitation were analyzed by 2D- and thereafter by 3D- TEE before and after surgery. The key intraoperative inclusion criteria was a LVEF < 30% confirmed by intraoperative 3D-TEE immediately before surgical remodeling.

Results Before surgery, the geometry of post infarction aneurysm shows negative curvatures of the antero-basal and infero-apical segment and the apex of LV is shifted clockwise, towards the mitral valve. Surgery had significantly reduced the LV volumes and the LVEF had increased by 13.3% as recorded by 2D-TEE and by 18.3% as assessed by 3D-TEE quantification (p < 0.001 for both). Accordingly, the longitudinal plane had been shortened, the apex was now shifted anti-clockwise towards the aorta and the inferior region had taken a more important function of the LV. Significantly lower values were observed in the EF measurement with 3D- vs 2D-TEE before remodelling (22.3 vs. 29.7%, p = 0.048).

Conclusion Improvement of LV function occurred due to the increased systolic contraction of the inferior region after remodelling in patients with postinfarction aneurysm.

Key words: intraoperative transesophageal echocardiography (TEE), real-time three dimensional TEE (RT-3D TEE), left ventricle, cardiac surgery

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