Study of Degenerative Mitral Regurgitation Using Three-Dimensional Echocardiography and EchoPAC GE Health Care Software 4D Auto MVQ: Comparison Between Transthoracic and Transesophageal Examination

Background: Preoperative echocardiographic assessment is critical for patients with severe degenerative mitral regurgitation to ensure personalized surgical mitral valve repair. This study aimed to compare the diagnostic accuracy of three-dimensional transthoracic echocardiography (3D TTE) and three-dimensional transesophageal echocardiography (3D TEE) in identifying valvular lesions, using surgical findings as the reference. Additionally, we evaluated whether annular dimensional parameters derived from TTE and TEE, using dedicated 3D software, could confirm whether 3D TTE alone offers a comprehensive preoperative evaluation. Methods: We enrolled 60 patients with severe organic mitral regurgitation scheduled for surgical valve repair. Each patient underwent preoperative 3D TTE, intraoperative 3D TEE prior to surgery, followed by annuloplasty. Mitral valve reconstructions from both TTE and TEE were compared, and dedicated 3D software (EchoPAC GE-Health-Care Software 3D-auto-MVQ) was employed to reconstruct annular geometries from both methods. Results: Both 3D TTE and 3D TEE demonstrated comparable accuracy in identifying diseased scallops (overall accuracy: 3D TTE 91.8%, 3D TEE 98.1%, p > 0.05). However, 3D TTE was inferior to 3D TEE in identifying multiple chordal ruptures (accuracy: 3D TTE 80%, 3D TEE 100%). Quantitative analysis of the mitral annulus revealed that 3D TTE and 3D TEE yielded overlapping results for static parameters (p > 0.05), whereas dynamic parameters differed significantly (p < 0.05). Conclusions: In the selected population, 3D TTE demonstrated diagnostic accuracy comparable to transesophageal echocardiography in identifying mitral valve lesions. Furthermore, with the use of dedicated 3D software, TTE alone may provide a comprehensive and noninvasive preoperative evaluation, particularly for static annular parameters. Further studies are warranted to corroborate these findings.