Non-invasive mitral tissue characterization using TrueVue transillumination: an imaging-histology correlation study.
Presented During:
Friday, May 5, 2023: 8:05AM - 8:10AM
New York Hilton Midtown
Posted Room Name:
Petit Trianon
Abstract No:
MO069
Submission Type:
Abstract Submission
Authors:
Mariateresa Librera (1), Stefania Paolillo (2), Guido Carlomagno (1), Carlo Briguori (1), Santo Dellegrottaglie (3), Alessandra Scatteia (3), Annarita Iavazzo (1), Antonio Mariniello (1), Saverio Nardella (1), Daniele Maselli (1)
Institutions:
(1) Mediterranea Cardiocentro, Naples, NA, (2) Federico Ii University, Naples, NA, (3) Clinica Villa dei Fiori, Acerra, NA
Submitting Author:
Mariateresa Librera
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Mediterranea Cardiocentro
Mediterranea Cardiocentro
Co-Author(s):
Stefania Paolillo
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Federico Ii University
Federico Ii University
Guido Carlomagno
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Mediterranea Cardiocentro
Mediterranea Cardiocentro
Carlo Briguori
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Mediterranea Cardiocentro
Mediterranea Cardiocentro
Santo Dellegrottaglie
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Clinica Villa dei Fiori
Clinica Villa dei Fiori
Alessandra Scatteia
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Clinica Villa dei Fiori
Clinica Villa dei Fiori
Annarita Iavazzo
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Mediterranea Cardiocentro
Mediterranea Cardiocentro
Antonio Mariniello
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Mediterranea Cardiocentro
Mediterranea Cardiocentro
Saverio Nardella
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Mediterranea Cardiocentro
Mediterranea Cardiocentro
Daniele Maselli
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Mediterranea Cardiocentro
Mediterranea Cardiocentro
Presenting Author:
Daniele Maselli
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Abstract:
Objective:
The feasibility of surgical repair of mitral regurgitation depends on the adequacy of valve tissue quality, and preoperative imaging should ideally predict valve tissue alterations to identify challenging cases. This has traditionally been done using 2D and 3D echocardiography.Here, we evaluate mitral valve tissue characterization by real-time TrueVue transillumination (TV) TEE, a new photorealistic rendering method, and its correlation with histopathology.
Methods:
TV TEE was performed in 15 patients with mitral valve disease requiring surgery; excised valve specimens were examined by a pathologist with proper staining.TV uses a virtual light source to illuminate a specific structure; we backlit mitral leaflets by positioning the light at the maximum depth provided by the technique; then, from the left atrium, we observed the light-tissue interaction which was different depending on the texture of the leaflets. Specifically, a fibrosclerotic degeneration is seen as a section of reduced penetration of the light, a fibroelastic deficiency can be observed as a section of hypertransparent tissue, while myxomatous degeneration is appreciated as areas of fibrotic tissue, scarcely crossed by light, surrounded by more transparent portions in a patchy pattern.Tissue composition was thus graded qualitatively, both at pathology and at TV, in a blinded fashion: 1 to fibrosclerotic degeneration, 2 to fibroelastic deficiency, and 3 to myxomatous degeneration. Anterior mitral leaflets were excised in toto and each portion (medial, central and lateral) scored separately; posterior leaflets were partially resected and scored individually. Cohen's kappa was used to detect the agreement between the two methods.
Results:
39 regions were included in the present analysis (13 anterior leaflets and 2 fragments of posteriors leaflets). A good correspondence was observed between TV tissue characterization and histological findings (Table 1), with a better concordance for fibrosclerotic degeneration (agreement 93%, p<0.001), but still high and significant concordance also for fibroelastic deficiency (agreement 87%, p<0.001) and myxomatous degeneration (agreement 87%, p<0.001).
Conclusions:
In our preliminary study, TV echocardiography demonstrated good prediction of mitral valve tissue characteristics confirmed by pathology. Larger studies will have to confirm the role of this new method in predicting feasibility and success of mitral repair.
The feasibility of surgical repair of mitral regurgitation depends on the adequacy of valve tissue quality, and preoperative imaging should ideally predict valve tissue alterations to identify challenging cases. This has traditionally been done using 2D and 3D echocardiography.Here, we evaluate mitral valve tissue characterization by real-time TrueVue transillumination (TV) TEE, a new photorealistic rendering method, and its correlation with histopathology.
Methods:
TV TEE was performed in 15 patients with mitral valve disease requiring surgery; excised valve specimens were examined by a pathologist with proper staining.TV uses a virtual light source to illuminate a specific structure; we backlit mitral leaflets by positioning the light at the maximum depth provided by the technique; then, from the left atrium, we observed the light-tissue interaction which was different depending on the texture of the leaflets. Specifically, a fibrosclerotic degeneration is seen as a section of reduced penetration of the light, a fibroelastic deficiency can be observed as a section of hypertransparent tissue, while myxomatous degeneration is appreciated as areas of fibrotic tissue, scarcely crossed by light, surrounded by more transparent portions in a patchy pattern.Tissue composition was thus graded qualitatively, both at pathology and at TV, in a blinded fashion: 1 to fibrosclerotic degeneration, 2 to fibroelastic deficiency, and 3 to myxomatous degeneration. Anterior mitral leaflets were excised in toto and each portion (medial, central and lateral) scored separately; posterior leaflets were partially resected and scored individually. Cohen's kappa was used to detect the agreement between the two methods.
Results:
39 regions were included in the present analysis (13 anterior leaflets and 2 fragments of posteriors leaflets). A good correspondence was observed between TV tissue characterization and histological findings (Table 1), with a better concordance for fibrosclerotic degeneration (agreement 93%, p<0.001), but still high and significant concordance also for fibroelastic deficiency (agreement 87%, p<0.001) and myxomatous degeneration (agreement 87%, p<0.001).
Conclusions:
In our preliminary study, TV echocardiography demonstrated good prediction of mitral valve tissue characteristics confirmed by pathology. Larger studies will have to confirm the role of this new method in predicting feasibility and success of mitral repair.
Mitral Conclave:
Imaging of Mitral Valve Disease
Image or Table
