Real time 3D echo has revolutionized assessment of mitral valve pathology and patient selection for surgical repair (Fig. 1).

3D color Doppler overcomes limitations of 2D and standard Doppler measurements for quantifying regurgitation such as technical limitations and geometrical assumptions in calculation of PISA method. Studies have shown the feasibility of measuring the 3D vena contracta (narrowest portion of the regurgitant jet), 3D PISA and 3D anatomic regurgitant orifice area (AROA) on 3D echo to assess severity of regurgitation for native regurgitant valve disease (Fig. 2).

3D TEE also improves procedural success and shortens procedure time for mitral valve interventions like interventional closure of paravalvular mitral regurgitation (Fig. 3) and deployment of the MitraClip™ device (Abbott Vascular Structural Heart, Menlo Park, CA). Altiok et al performed a structured analysis and found 3D TEE advantageous in 9 of 11 steps of the percutaneous mitral repair procedure.