Intraoperative Applications

Intraoperative Applications

The accuracy, feasibility, and value of 3D echocardiography

also have been demonstrated in the

intraoperative environment. Intraoperative 3D

echocardiography provides accurate and often

additional anatomic information compared with

2D transesophageal (TEE) imaging.123 In limited

studies examining 2D and 3D TEE intraoperative

evaluation of mitral valve prolapse anatomy, 3D

TEE evaluation provided complementary and additional

information compared with 2D TEE for

localization of prolapsed scallops (video clip

14).77,124 Intraoperative 3D TEE also has been

used to identify distortion and folding of the mitral

annulus as a cause of functional mitral stenosis or

worsening mitral regurgitation during beatingheart

surgery.125 Finally, intraoperative 3D TEE

has proven valuable in patients undergoing surgery

for congenital heart lesions. For example, the

superiority of intraoperative 3D TEE compared

with 2D has been demonstrated by its ability to

provide en face and oblique views of left atrioventricular

valve malformations in patients undergoing

reoperation for persistent regurgitant lesions

after previous repair of atrioventricular septal

defects.78,126

Intraoperative epicardial RT3D echocardiography

has been used to improve spatial orientation

and assess the extent of septal thickening, mitral

valve systolic anterior motion, and postsurgical LV

outflow tract patency in a patient with hypertrophic

cardiomyopathy undergoing septal myectomy,.

127 It also has been used to guide and monitor

off-pump atrial septal defect closure in a beatingheart

animal model.128 Finally, intraoperative epicardial

and postoperative transthoracic RT3D

echocardiography has been used to evaluate

changes in LV volume and function during cardiac

surgery in patients undergoing infarct exclusion

surgery for ischemic cardiomyopathy.69 In contrast

to 3D echocardiographic imaging, conventional

2D methods may not accurately quantify LV

volumes in patients with severe ischemic cardio

cardiomyopathy,

especially in the presence of significant

geometric changes due to LV aneurysm.