Real time three-dimensional transesophageal echocardiography for guiding percutaneous mitral valvuloplasty.

摘要

A 50-year-old woman with symptomatic moderate mitral valve stenosis of rheumatic origin and mild mitral regurgitation underwent percutaneous mitral valvuloplasty (PMV). The Wilkins score of the mitral valve was 8, with minimal calcification of the valve and sub-valvular apparatus, commissural fusion, moderate thickening of the leaflets, and moderate reduction of its mobility. Mitral valve area determined by pressure half-time method, by proximal isovelocity surface area method and by direct planimetry using real time three-dimensional transesophageal echocardiogra- phy (RT3D-TEE) was 1.1 cm2. Under general anesthesia, the procedure was guided by conventional fluoroscopy and RT3D-TEE with an iE33 system and X7-2t transesophageal transducer (Koninklijke Philips Electronics N.V., Eindhoven, The Netherlands). The anterograde approach with Inoue technique was selected. The monitoring with echocardiography played a key role at three points of the procedure: transseptal catheterization that allows access to the left atrium (Fig. 1), positioning of the Inoue balloon across the valve (Fig. 2), and its inflation (Fig. 3A and 3B), and postprocedure mitral valve area assessment (Fig. 3C). The procedure was successful and mitral valve area measured with RT3D-TEE after two dilations was 2.5 cm2 (Fig. 4).