MO69. Non-Invasive Mitral Tissue Characterization Using Truevue Transillumination: An Imaging-Histology Correlation Study
Presented During: Mini-Orals: Translational Research, Innovation, Predictive Modeling
Roma
Italy - Contact Me
AGE 58. HE IS DIRECTOR OF THE DEPARTMENT OF CARDIAC SURGERY OF THE CLINICA MEDITERRANEA IN NAPLES (ITALY) SINCE FEBRUARY 2021.
FORMER DIRECTOR OF THE DEPARTMENT OF CARDIOVASCULAR SURGERY SANT'ANNA HOSPITAL CATANZARO, ITALY FROM 2013 TO 2021.
HE HAS LED MINIMALLY INVASIVE CARDIAC SURGERY UNITS AT SAN CAMILLO HOSPITAL, ROME, ITALY, (SINCE 1999), UNIVERSITY OF PISA, PISA, ITALY, (SINCE 2004), EUROPEAN HOSPITAL, ROME , ITALY (SINCE 2006) ACCUMULATING LARGE EXPERIENCE IN MINIMALLY INVASIVE AORTIC VALVE AND AORTIC SURGERY, OFF PUMP CORONARY SURGERY, ENDOSCOPIC MAMMARY ARTERY HARVESTING, ENDOSCOPIC MITRAL VALVE SURGERY.
HE IS AN EXPERT OF ENDOSCOPIC MITRAL VALVE SURGERY.
Friday, May 5, 2023: 8:05 AM - 8:10 AM
5 Minutes
New York Hilton Midtown
Room: Petit Trianon
Description
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.
Presentation Duration
3-minute presentation; 2-minute discussion