Assessment Of Mechanical Prosthetic Valves With Real-time Three-dimensional Echocardiography: An Initial Study

Objective To evaluate the possibility and accuracy of real-time three-dimensional echocardiography (RT-3DE) in the assessment of the mechanical prosthetic valve apparatus's configuration and function in patients with prosthetic valves replacement ,and to explore the superiority and the clinical value of RT-3DE.Methods Fifty patients experienced the mitral valve (MV) replacement or/ and aortic valve (AV) replacement separately. RT-3DE was used to observe the structure , neighbor relationship of artificial valve and its bracket , and evaluate hemodynamic changes. Meanwhile, they were measured by TTE method.Results (1) 92.6 % (25/ 27) patients with MV replacement could be successfully observed by real-time gray-scale 3DE; the structure and motion of prosthesis MV in 73.3% (11/15) patients with MV and AV replacement could be successfully observed by real-time gray-scale 3DE. There was still a problem to accurate display the structure and the motion of prosthetic AV , the appearance rate was only 56.5%(13/ 23) . (2) real-time color 3DE could be used to assess the valve regurgitation and the leakage around the mechanical prosthetic valve. The outcome of RT- 3DE method and 2DE method is rather consistent, the Kappa value of judgment by the two methods was 0.716 in the valve regurgitation, 0.735 in the perivalvular leakage, respectively (P <0.001), and the Spearman correlation value was 0.717, 0.888 , respectively (P <0.001). Conclusion Mechanical posthetic valve apparatus's structure , motion and the flow dynamics could be accurately detected by RT-3DE. Compared with transthoracic echocardiography ( TTE), RT-3DE can provide more additional information of anatomic structure and hemodynamics, is recognized as an important complement of transthoracic echocardiography ( TTE) and transesophageal echocardiography ( TEE) when assessing prosthetic valve function.