Abstract
BACKGROUND: A comprehensive transesophageal echocardiography (TEE) examination is nowadays common practice in cardiac surgical procedures. The introduction of 3D technology enables a simultaneous multiplane display of 2D views (X-plane) which can shorten the duration of the TEE examination; however, X‑plane imaging results in a decrease in temporal resolution which can affect the accuracy of routine anatomical linear measurements. The 3D-TEE imaging enables multiplanar reconstruction of 3D datasets and to freely position perpendicular 2D planes to measure anatomical structures more accurately, which has been shown to strongly correlate to computed tomography and magnetic resonance imaging. OBJECTIVE: Does the integration of multiplane imaging shorten the time of a comprehensive TEE examination without affecting the accuracy of routine 2D anatomical linear measures? MATERIAL AND METHODS: In a prospective randomized comparative study, patients scheduled for elective cardiac surgery underwent a comprehensive intraoperative TEE examination (Philips CX 50 with X‑72T probe). They were divided into two groups. In the routine protocol (RP) group, the TEE examination was conducted according to the standardized departmental image acquisition protocol, while in the study protocol (SP) group, multiplane views were integrated into the RP to replace the corresponding 2D views. The examinations were conducted by two experienced echocardiographers. At the end of the assigned examination protocol the timer was stopped and the missing views were obtained (2D for the X‑plane and vice versa) as well 3D datasets of the mitral valve, aortic valve and left ventricle. Measurements of mitral and aortic annuli as well as left ventricular length from 2D and X-plane views were subsequently performed offline. Measurements obtained from a multiplanar reconstruction of a full volume (FV) 3D dataset from the same patient were used as the gold standard to compare measurements in RP and SP. RESULTS: The examination time was significantly shorter in the SP group (SP: 481 ± 60 s; RP 595 ± 60 s; p < 0,001). There was no significant difference for any of the measurements using the SP and RP. The mean percentage error, although not statistically significantly different, was numerically smaller for the X‑plane than for 2D method compared to 3D except for the mitral valve annulus. Overall, X‑plane tended to show lower variability compared to 2D. CONCLUSION: Integrating multiplane views into a standardized comprehensive TEE image acquisition protocol reduces the examination time. The accuracy of standardized linear measurements in X‑plane mode is comparable to that of conventional 2D imaging.