3D Echocardiography for Rheumatic Heart Disease Analysis: Ready for Prime Time

Figures

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  Figure 1. RHD (mitral valve stenosis). (A) M mode transthoracic echocardiography. Demonstration of patient with severe mitral valve stenosis (rectification of E to F slope), presenting atrial fibrillation. (B) 2D transthoracic echocardiography, transversal view, thickening of mitral valvular leaflets, “buttonhole” shape of the mitral valve. (C) 3D transthoracic echocardiography, mitral valve chordae fusion. (D) 2D transthoracic echocardiography, transversal view, measurement of the mitral valve area by planimetry: 0.528 cm2. RV, right ventricle; LV, left ventricle; AO, aorta; LA, left atrium.

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  Figure 2. RHD (Mitral valve stenosis). (A) 3D transthoracic echocardiography, left atrium view, 2D reference structures, patient with severe valve mitral stenosis. (B) 3D transthoracic echocardiography, patient with severe valve mitral stenosis. (C) 3D transthoracic echocardiography, view from left atrium (right) and from the left ventricle (left), patient with severe valve mitral stenosis.

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  Figure 3. RHD (Mitral valve stenosis). (A) 3D transesophageal echocardiography. Demonstration of patient with severe mitral valve stenosis, “fishmouth” shape of the mitral valve. (B) 3D transesophageal echocardiography, same patient, measurement of the mitral valve area by planimetry: 0.741 cm2. LAAE, left atrium appendage; AV, aortic valve; MV, mitral valve.

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  Figure 4. Acute rheumatic fever (carditis). (A) Myocardial Aschoff bodies of rheumatic fever (Hematoxylin and eosin stain). (B) 3D transthoracic echocardiography depicting normal left ventricle. (C) 3D left ventricle presenting myocardial dysfunction, in red abnormal left ventricular synchronicity. 2D Global longitudinal: −12%.

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  Figure 5. Infective endocarditis (aortic valve and tricuspid valve). (A) Macroscopy: small vegetations all over the aortic valve. (B) 3D transthoracic echocardiography depicting vegetations over the tricuspid valve (arrows). (C) Macroscopy: vegetations all over the tricuspid valve. (D) Microcospy: small fibrine thrombi in organization. RV, right ventricle; RA, right atrium; TV, tricuspid valve.

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  Figure 6. RHD (mitral valve stenosis). 3D transesophageal echocardiography. Demonstration of balloon valvuloplasty in patient with severe mitral valve stenosis (A,B). 3D transesophageal echocardiography. Demonstration of mitral valve commissural opening (arrows, C) after balloon valvuloplasty. LAAE, left atrium appendage; AV, aortic valve; MV, mitral valve; TR, tricuspid valve.

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  Figure 7. RHD (mitral valve stenosis, stenotic bioprosthesis). 3D transesophageal echocardiography. Demonstration of mitral valve bioprosthesis stenosis. (A) Atrial view. (B) Ventricular view. LAAE, left atrium appendage; MVBP, mitral valve bioprosthesis.

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  Figure 8. RHD (mitral valve stenosis, stenotic bioprosthesis). (A) 3D transesophageal echocardiography. Demonstration of mitral valve bioprosthesis stenosis (comparison with 2D transesophageal echocardiography). (B) 3D transesophageal echocardiography. Demonstration of mitral valve bioprosthesis stenosis (color Doppler).

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  Figure 9. Tricuspid valve rheumatic analysis. (A) Macroscopy: the tendinous cords are thickened, fused, and retracted (lack of intercordal spaces), and the anteroseptal commissure is fused. The leaflets show thickening of the free edges. (B) 3D echocardiography (right atrial view). Demonstration of lack of coaptation leading to an important regurgitation. S, septal cusp; A, anterior cusp; P, posterior cusp.

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  Figure 10. Left and right ventricle analysis by 3D echocardiography (artificial intelligence). (A) Right ventricle analysis. (B) Left ventricle and left atrium analysis.

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  Figure 11. Rheumatic heart disease (Mitral and aortic valves). (A) Mitral valve: ventricular surface of the anterior leaflet showing diffuse fibrous thickening. The tendinous cords are thickened, fused, and retracted (lack of intercordal spaces). (B) Mitral valve: atrial aspect of the same valvar leaflet showing diffuse thickening and a scar of previous valvular commisurotomy (arrow). (C) Aortic valve: surgical specimen showing leaflets thickening and comissural fusion, arterial view. (D) Aortic valve: leaflets thickening, commissural fusion and calcification, ventricular view.

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  Figure 12. Mitral valve bioprosthesis (MVBP). (A) Macroscopy: MVBP in a patient with infective endocarditis. Vegetations (arrows). (B) Normal MVBP demonstrated by 3D echocardiography (transluminescence technique).