الفهرس 
Three-dimensional Transesophageal echocardiography versus Two Dimensional Transesophageal echocardiography in evaluation of the left sided prosthetic valve dysfunction in critically ill patients
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Abstract
Two dimensional Transesophageal Echocardiography (2D TEE) is a semi-invasive imaging technique for the evaluation of suspected PHV dysfunction.. Limitations of 2D TEE are acoustic shadowing by prosthetic material, acquisition and interpretation of TEE images are operator-dependent and require considerable experience. Three-Dimensional (3D) echocardiography is the recent method for evaluation of prosthetic valve function. Advancements in computer and transducer technologies permit real-time 3DE acquisition and presentation of cardiac structures from any spatial point of view.
Objective: Comparison between 2D and 3DTEE in detecting prosthetic valve dysfunction.
Methods: A prospective study included 70 patients (54.3 % males) conducted at Critical Care Unit at National Heart Institute admitted due to suspected infective endocarditis , congestive heart failure and arrhythmia. They were referred for echocardiographic evaluation of PV with suspicion of PV dysfunction (clinically and by transthoracic 2DE). Patients were recruited between September 2019 and September 2021. Both 2DTEE and 3DTEE were performed using the same matrix probe (X7-2) connected to Philips Epiq 7 made in Netherlands.
Results: 3DTEE was superior to 2DTEE and statistically significant in detecting the abnormal motion of leaflets p value (<0.001), calcification (P value <0.001). In infective endocarditis there was a statistically significant difference between 2D and 3DTEE in detecting the number of patients having vegetation. (pvalue < 0.001). Meanwhile, Vegetation detected by 2DTEE showed sensitivity 75%, specificity 100%, PPV 100%, NPV 93.1% and accuracy 94%). There was statistically significant difference between 2D and 3DTEE in detecting the number of patients having abcess (P value = 0.034). In 2DTEE, sensitivity, specificity, PPV, NPV and accuracy is 50%, 100%, 100%,98.2% and 81% respectively. There was a statistically significant difference between 2D and 3DTEE in detecting thrombus (P value <0.001). 2DTEE sensitivity, specificity, PPV, NPV and accuracy were 62.5%, 100%, 100%, 83.6% and 87% respectively. There was a statistically significant difference between 2D and 3DTEE in detecting the number of patients having pannus (P value = 0.001). The sensitivity of 2DTEE was 33.3%, specificity 100%, PPV 100%, NPV 87.9% and accuracy 89%. In PVL, 3DTEE was superior to 2DTEE in detecting the number of leaks, morphology, location and severity (P value <0.001)
Conclusion: Our study demonstrates the superiority of 3DTEE over 2DTEE in the evaluation of Paravalvular regurge, prosthetic valve apparatus especially valve sewing ring integrity. 3DTEE provides adequate analysis of the vegetation size, thrombus and pannus size and location.