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Original Articles: Adult Cardiac

Value of Augmented Reality-Enhanced Transesophageal Echocardiography (TEE) for Determining Optimal Annuloplasty Ring Size During Mitral Valve Repair

Joerg Ender, MD^a,_*, Jasmina Konar-Zeh, MD^a, Chirojit Mukherjee, MD^a, Stephan Jacobs, MD^b, Michael A. Borger, MD, PhD^b, Christoph Viola, BS^c, Michael Gessat, BS^d, Jens Fassl, MD^a, Friedrich W. Mohr, MD, PhD^b, Volkmar Falk, MD, PhD^b

^a Department of Anesthesiology and Intensive Care Medicine II, Leipzig Heart Center, University of Leipzig, Leipzig, Germany
^b Department of Cardiac Surgery, Leipzig Heart Center, University of Leipzig, Leipzig, Germany
^d Innovation Center for Computer Assisted Surgery, University of Leipzig, Leipzig, Germany
^c TomTec, Munich, Germany

Accepted for publication July 14, 2008.

^_* Address correspondence to Dr Ender, Department of Anesthesiology and Intensive Care Medicine II, Leipzig Heart Center, University of Leipzig, Struempellstr 39, Leipzig, 04289, Germany (Email: joerg.ender{at}medizin.uni-leipzig.de).

Background: Mitral valve (MV) annuloplasty is an integral part of MV repair, but sizing under direct vision is occasionally challenging. Furthermore, traditional sizing is not possible for percutaneous MV repair techniques. This study compared augmented reality-enhanced three-dimensional (3D) transesophageal echocardiography (TEE) for determining MV annuloplasty size with conventional surgical sizing.

Methods: In patients undergoing elective MV repair, a 3D MV reconstruction was performed using TEE. Modified 4D valve assessment software was used to create 3D computer-aided design models of standard annuloplasty rings (28 to 36 mm), which were stored in a digital database. These virtual 3D annuloplasty ring templates were superimposed on the preoperative 3D TEE reconstructions of the MV, and results were compared with conventional sizing under direct vision. A post hoc validation of the 3D models was performed using the implanted rings as a control. The echocardiographer was blinded to the implanted ring size.

Results: The study included 50 patients. The correlation between the selected 3D annuloplasty ring template and the implanted annuloplasty ring size was 0.83. Thirty ring templates (60%) were the same size as the implanted annuloplasty ring, 19 templates (38%) differed by ±2 mm in size, and 1 template differed by +4 mm. Postoperatively, the validation protocol revealed a correlation of 0.94 between the size of the ring templates and the implanted annuloplasty prostheses.

Conclusions: Augmented reality-enhanced TEE for determining optimal annuloplasty ring size during MV repair correlates well with conventional surgical sizing and may facilitate future percutaneous MV repair techniques.

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Invited Commentary

James I. Fann
Ann. Thorac. Surg. 2008 86: 1478-1479. [Extract] [Full Text] [PDF]

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