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Open access

Caroline Bleakley, Mehdi Eskandari, and Mark Monaghan

Transcatheter aortic valve implantation (TAVI) was initially proven as an alternative to valve replacement therapy in those beyond established risk thresholds for conventional surgery. With time the technique has been methodically refined and offered to a progressively lower risk cohort, and with this evolution has come that of the significant imaging requirements of valve implantation. This review discusses the role of transoesophageal echocardiography (TOE) in the current TAVI arena, aligning it with that of cardiac computed tomography, and outlining how TOE can be used most effectively both prior to and during TAVI in order to optimise outcomes.

Open access

Ramasamy Manivarmane, Rebecca Taylor, and Rajdeep Khattar

Our case highlights the finding of an abnormal pulmonary valve on 2D echocardiography, confirmed to be of bicuspid morphology with 3D imaging. The use of biplane imaging both in transthoracic and transoesophageal echocardiography and routine use of three-dimensional views particularly in transoesophageal echocardiography are of incremental value in better delineating pulmonary valve anatomy.

Learning points:

  • Bicuspid pulmonary valve as an isolated clinical entity is a rare finding in clinical practice with an incidence of about 0.1%.

  • The true prevalence of the condition may be underestimated because of difficulty in visualising the pulmonary valve en-face on standard two-dimensional echocardiography.

  • Trans-oesophageal echocardiography may provide better visualization of the pulmonary valve when transthoracic images are affected by interference from the left lung.

  • Routine use of 3D echocardiography with biplane and zoomed views should be advocated for a full morphological assessment of the pulmonary valve, whether imaging via the transthoracic or transoesophageal approach.

Open access

Cheuk-Man Yu

The advancement of echocardiography in the past two decades is more than downsizing of the machines and improvement of image quality, but introduction of new imaging modalities leading to the ability of performing quantitative analysis. This function is greatly facilitated by the integration of echo machines with high performance computers, software programming and establishment of workstation for offline analysis. Today, echo examination is more than estimation of ejection fraction (EF) and patterns of left ventricular (LV) diastolic dysfunction. Echosonographers are facing a large number of quantitative parameters for interpretation. In newer imaging modalities such as tissue Doppler imaging, speckle tracking, 3-dimensional echocardiography and 3D-transoesophageal echocardiography, quantitative echocardiographic assessment has important roles. These have brought many opportunities but also challenges in our echo practice.

Open access

Alexandra Savis and John Simpson

Echocardiography is the imaging modality of choice to diagnose different types of atrial septal defect and to determine which defects are suitable for catheter occlusion. In addition to assessment of defect size and rims, transoesophageal echocardiography may be used to guide the procedure itself including device placement, procedural complications and post-procedural checks. This review covers a practical approach to this subject and is accompanied by online videos illustrating the technique.

Open access

Patrick Savage and Michael Connolly

Summary

Mitral valve repair is the gold standard treatment for degenerative mitral valve disease with superior perioperative and long-term morbidity and mortality outcomes vs mitral valve replacement. The 10 year survival freedom from redo valve repair varies from 72 to 90%. Often, failure of valve repair necessitating redo surgery is directly related to disease progression; however, rarely it can be attributed to technical complications such as annuloplasty dehiscence, leaflet suture rupture, incorrect artificial chord length or incorrect annuloplasty position. We report one such case of severe mitral regurgitation secondary to a degenerative annuloplasty ring suture occurring 1 year post valve repair.

Learning points:

  • Differentiation of causative pathology involved in recurrent mitral regurgitation following repair has important implications for patient outcomes.

  • In the hands of an experienced practitioner echocardiography – in particular, integrated 2D- and 3D echocardiography – is a powerful tool for differentiating between progressive disease and procedural failure.

Open access

Viren Ahluwalia, Faizel Osman, Jitendra Parmar, and Jamal Nasir Khan

Summary

Despite 3D echocardiography (3DE) acquiring significantly greater data than standard 2D echocardiography (2DE), it is underutilised in assessing cardiac anatomy and physiology. A key advantage is the ability of a single 3DE acquisition to be post-processed to generate volume-rendered 3D models and an unlimited number of multiplanar reconstruction (MPR) images. We describe the case of a highly anxious patient with life-threatening complex aortic valve endocarditis and aortic root abscess, refusing transesophageal echocardiography (TOE) under general anaesthesia with tachycardia, breathlessness and acute kidney injury precluding accurate or safe gated (computed tomography) CT, who was comprehensively assessed with a rapid 3D-TOE under sedation. This led to timely surgery and an excellent outcome for the patient.

Learning points:

  • 3DE is of greater clinical value than 2DE as it is able to post-process a single 3DE image acquisition into volume rendered 3D models, and provide an unlimited number of multiplanar reconstruction (MPR) images.

  • 3DE is highly effective in difficult cases where speed is important.

  • 3DE is superior in the planning of complex surgical cases.

Open access

Jun K Teoh and Richard P Steeds

posterior mitral annulus. Figure 2 2D transoesophageal echocardiography (mid-oesophageal 0° view; A2/P2 level) image of CAT ‘dangling’ on the upstream/atrial side of the mitral valve. Figure 3 3D transoesophageal echocardiography image of CAT projecting in

Open access

Patrick Savage and Michael Connolly

right hand side) demonstrates dyssynchronous closure of both leaflets. View Video 2 at http://movie-usa.glencoesoftware.com/video/10.1530/ERP-20-0012/video-2 . Download Video 3 Video 3 3D-Transoesophageal echocardiography demonstrating mobile

Open access

Madalina Garbi and Mark J Monaghan

-guided 2D slices using a technique called multi-plane reconstruction (MPR). Integrated measurements obtained at end-systole with 3D transoesophageal echocardiography (TOE) have been used to generate static models of the valve morphology, which demonstrate

Open access

Boyang Liu, Nicola C Edwards, Simon Ray, and Richard P Steeds

from this study suggest that rates of late failure are falling, possibly as a result of technical improvements such as routine use of ring annuloplasty and peri-operative 3D transoesophageal echocardiography, recurrence of MR after MV repair is