PMC6777188_01
Assessment of the mitral valve prior to and after minimally invasive robotic valve repair using 2D and 3D transoesophageal echocardiography. A - Eccentric jet of significant mitral regurgitation (arrow) - color Doppler. B - "Surgical view" of the mitral valve: posterior leaflet prolapse and broken native chords to P2 scallop (arrows). C - Severe mitral regurgitation: a wide jet and large convergence zone (arrow) - color Doppler. D - "Surgical view" of the mitral valve: posterior leaflet prolapse and a cleft within the P2 segment (arrow). E - The da Vinci camera view of the mitral valve in the first patient after excision of the prolapsing segment and annulus implantation. F - Good final result of the robotic procedure assessed by 3D-TEE. AML - anterior mitral leaflet, LA - left atrium, LV - left ventricle, PML - posterior mitral leaflet, P2 - central segment of posterior mitral leaflet.
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3D-TEE performed in the operating room allowed us to evaluate in detail the mechanism of MR and confirmed at least three broken native chords to the P2 scallop in the first patient (Figure 1 B), and P2 prolapse with a significant cleft in the middle of the scallop in the second one (Figure 1 D). After left atriotomy, the da Vinci camera view revealed the MV anatomy comparable to the view by 3D-TEE (Figure 1 E). After CPB was stopped, good MV competence using 2D-TEE and color Doppler was confirmed, and the final result was clearly shown by 3D-TEE (Figure 1 F).