Assessment of flail mitral leaflets by dynamic three-dimensional echocardiographic imaging

In mitral valve repair in patients with a flail mitral leaflet, proper recognition of involved lesions is extremely important for the surgeon.(1,2) However, the operators have to reconstcuct isolated tomographic views of the mitral valve mentally into 3-dimensional images to understand spatial relations of the involved lesion from conventional 2-dimensional images. Dynamic 3-dimensional images provide more realistic visualization of cardiac morphology compared with 2-dimensional echocardiography.(3-9) Furthermore, multiplane transesophageal echocardiography (TEE) enables 3-dimensional reconstructions of the mitral valve to be produced from high-quality multiple 2-dimensional images by rotation of the transducer without changing its position.(7,10-13) Although there are some reports demonstrating 3-dimensional images of the mitral valve,(5-7,9) there have been no systematic studies regarding the evaluation of the involved leaflet in patients with a flail mitral leaflet by dynamic 3-dimensional images. The purpose of this study was to evaluate the diagnostic accuracy of 3-dimensional echocardiographic images in assessing the involved lesion in patients with a flail mitral leaflet.