Three-Dimensional Echo and Three-Dimensional Transesophageal Echocardiography for Mitral Valve Disease

Three-dimensional (3D) echocardiography is one of the greatest technologies, which has a significant contribution in the field of valvular heart disease, especially after the development of real-time (RT) capability in transthoracic as well as transesophageal imaging during the past decade. RT 3D transesophageal echo has provided a simplified imaging tool for the anatomy of mitral valve (MV), including the MV annulus, leaflets, and subvalvular apparatus. Three scallops of anterior and posterior leaflets are easily recognized. This helps in localizing the MV abnormality, for example, MV prolapse and flail MV. This also helps in localizing the mitral regurgitation (MR). Even the quantification of MR has also seen a novel understanding of RT 3D planimetry of MR jet, which is possible by newer machines. Commissural inequality and calcification is well identified, and it helps in choosing the cases for percutaneous balloon mitral valvuloplasty. More recently, this technology with RT 3D transesophageal echocardiography has found a role in interventional procedure, for example, balloon mitral valvuloplasty, paravalvular leak closure, and edge-to-edge (MitraClip) repair of degenerative MV.