Real-time 3-dimensional transesophageal echocardiography assessment of left ventricular shape and function after surgical remodelling 

Background

Real-time three dimensional transoesoph-ageal 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 ad-vantages of 3D analysis in shape assessment and to quantify the LV volume by ejection fraction (EF) measurement, after LV surgi-cal remodelling.

Methods

In a prospective manner, twenty consecu-tive coronary surgery patients with LV an-teroapical 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 infarc-tion aneurysm shows negative curvatures of the antero-basal and infero-apical seg-ment and the apex of LV is shifted clock-wise, 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 as-sessed 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. Signifi-cantly 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 pa-tients with postinfarction aneurysm.

intraoperative transesophageal echocardiography (TEE), real-time three di-mensional TEE (RT-3D TEE), left ventricle, cardiac surgery

1. Kisslo J, Firek B, Ota T, Kang DH, Fleishman CE, Stetten G, et al. Real-time volumetric echocardiography: the technology and the possibilities. Echocardiography 2000;17:773-80.

2. Vegas A, Meineri M. Three-dimensional transesophageal echocardiography is a major advance for intraoperative clinical manage-ment of patients undergoing cardiac surgery: a core review. Anesth Analg 2010;110:1548-73.

3. Shanewise JS, Cheung AT, Aronson S, Stewart WJ, Weiss RL, Mark JB, et al. ASE/SCA guidelines for performing a comprehensive intraoperative multiplane transesophageal echocardiography examination: recommendation of the American Society of Echocardi-ography Council for Intraoperative Echocardiography and the Society of Cardiovascular Anesthesiologists Task Force for Certifica-tion in Perioperative Transesophageal Echocardiography. J Am Soc Echocardiogr 1999;12:884-900.

4. Mor-Avi V, Sugeng L, Lang RM. Real-time 3-dimensional echocardiography: an integral component of the routine echocardio-graphic examination in adult patients? Circulation 2009;119:314-29.

5. Di Mauro M, Iaco AL, Bencivenga S, Clemente D, Marcon S, Asif M, et al. Left ventricular surgical remodelling: is it a matter of shape or volume? Eur J Cardiothorac Surg 2015;47:473-9.

6. Kwan J, Gilinov MA, Thomas JD, Shiota T. Geometric predictor of significant mitral regurgitation in patients with severe ischemic cardiomyopathy, undergoing Dor procedure: a real-time 3D echocardiography study. Eur J Echocardiography 2007;8:195-203.

7. Monaghan MJ. Role of real time 3D echocardiography in evaluating the left ventricle. Heart 2006;92:131-6.

8. Hibberd MG, Chuang ML, Beaudin RA, Riley MF, Mooney MG, Fearnside JT, et al. Accuracy of three-dimensional echocardiog-raphy with unrestricted selection of imaging planes for measurement of left ventricular volumes and ejection fraction. Am Heart J 2000;140:469-75.

9. Mannaerts HF, van der Heide JA, Kamp O, Stoel MG, Twisk J, Visser CA. Early identification of left ventricular remodelling after myocardial infarction, assessed by transthoracic 3D echocardiography. Eur Heart J 2004; 25: 680–7.

10. Otterstad JE. Measuring left ventricular volume and ejection fraction with the biplane Simpson’s method. Heart 2002; 88:559–60.

11. Bottini PB, Carr AA, Prisant LM, Flickinger FW, Allison JD, Gottdiener JS. Magnetic resonance imaging compared to echocardiog-raphy to assess left ventricular mass in the hypertensive patient. Am J Hypertens 1995; 8:221–8.

12. Nikitin NP, Constantin C, Loh PH, Ghosh J, Lukaschuk EI, Bennett A, et al. New generation 3-dimensional echocardiography for left ventricular volumetric and functional measurements: comparison with cardiac magnetic resonance. Eur J Echocardiogr 2006:7:365-72.

13. Tighe DA, Rosetti M, Vinch CS, Chandok D, Muldoon D, Wiggin B, et al. Influence of image quality on the accuracy of real time three-dimensional echocardiography to measure left ventricular volumes in unselected patients: a comparison with gated-SPECT imaging. Echocardiography 2007;24:1073-80.

14. Jenkins C, Chan J, Hanekom L, Marwick TH. Accuracy and feasibility of online 3-dimensional echocardiography for measurement of left ventricular parameters. J Am Soc Echocardiogr 2006; 19:1119–28.

15. Vegas A. Three-dimensional transesophageal echocardiography: principles and clinical application. Ann Card Anaesth 2016:19(Sup-pl 1):35-43.