Three-dimensional Echocardiography in the Assessment of Prosthetic Valves

Over the past few decades, transesophageal echocardiography (TEE) has evolved from one-dimensional imaging using a probe with a single-crystal, M-mode transducer to two-dimensional imagingwith phased-array transducers and now three-dimensional (3D) imaging with matrix array transducers. Current 3D imaging probes are vastly superior to the earlier technique of using multi-plane TEE imaging to reconstruct 3D images. While these earlier techniques enabled improved visualization of valvular anatomy, acquisition of images was tedious and time-consuming and extensive post-processing was required to generate images. As well, image quality was poor and frequently affected by artifact limiting its use for research purposes. Recent advancements in real-time three-dimensional (RT3D) TEE have propelled 3D TEE imaging into clinical practice from the research realm. With the development of the matrix array TEE probe real-time acquisition and on-line display of 3D TEE images are now easy to acquire and there is no need for either sequential multi-plane acquisition or off-line reconstruction. These images have enabled the visualization of valvular anatomy from unique orientations with improved spatial relationships not previously seen with 2D echocardiography. In particular, RT3D TEE has allowed improved visualization and assessment of prosthetic valves. In this editorial, we will discuss the use of RT3D TEE in the assessment of prosthetic valves, their associated complications such as prosthetic valve endocarditis and paravalvular regurgitation as well as limitations and future uses of RT3D TEE.