Key result
Real-time 3D TEE reliably identifies isolated posteromedial commissural prolapse in severe mitral regurgitation.
Case Report (n=1)
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3D TEE clarified mitral valve prolapse missed on 2D imaging; leaves open its incremental value for surgical planning in larger cohorts.
A 62-year-old man presented with progressive exertional dyspnea and a holosystolic murmur.A transthoracic echocardiogram showed severe eccentric mitral regurgitation (Fig. 1).A 2-dimensional transesophageal echocardiogram (2D TEE) showed possible anterior mitral leaflet perforation (Fig. 2).The patient was referred for surgery.Intraoperative, real-time 3-dimensional (3D) TEE clearly showed isolated posteromedial commissural prolapse involving the anterior and posterior leaflets (A3 and P3 scallops) (Fig. 3).The cause was fibroelastic deficiency that resulted in rupture of the commissural chordae (Fig. 4), which was confirmed upon surgical inspection (Fig. 5).The mitral valve was successfully repaired.
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Kareti et al. (2014) conducted a case report in Severe eccentric mitral regurgitation (n=1). Real-time 3-dimensional transesophageal echocardiography vs. 2-dimensional transesophageal echocardiography was evaluated. Real-time 3-dimensional transesophageal echocardiography clearly identified isolated posteromedial commissural prolapse causing severe mitral regurgitation, which was confirmed upon surgery.
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