Advanced 3D Imaging Aids Early Detection and Guides Mitral Valve Repairs

Advanced 3D Imaging Aids Early Detection and Guides Mitral Valve Repairs

Before heart disease set in, Terry Gentner led an active life working for the U.S. Navy as a contracted submarine acoustic equipment maintenance manager with the Royal Saudi Navy for 13 years during the Gulf War. “You would think that if I was going to have heart events, they should have occurred during the Scud attacks in Al Jubail,” says Terry.

During that time, he traveled out of the country four to five times a month from his home base in San Diego. His daughter, Jenna Gentner, a registered nurse at The University of Arizona Medical Center – University Campus, recalled how her father was active in family outings, including sailing, camping, hunting, fishing, playing in the snow in the mountains and leading Cub Scouts.

In 2007, Terry, who now lives in Ajo, Ariz., was diagnosed in Phoenix with atrial fibrillation. “Slowly all of his activities were taken away from him. By the time we realized how much his health had deteriorated, all of this was snatched from him,” says Jenna.

“I got to the point where I couldn’t walk across a room or lie down to sleep; I needed a lounge chair for sleep; and my legs were occasionally swelling,” says Terry, age 75. During his recent bout with congestive heart failure, Terry was admitted to UAMC – University Campus, out of breath and with his chest full of fluid. A routine two-dimensional echocardiogram suggested a possible leaking valve, but the exact mechanism and severity of the leak was unclear.

“With advanced three-dimensional transesophageal echocardiography (3D-TEE), I was able to clearly see that Terry had a significant mitral valve leak where one of the valve leaflets was being pulled by a weak area in the heart muscle. With 3D-TEE imaging, the surgeon was given all the necessary information to guide a successful repair. Based on these images prior to surgery, I informed Terry that the surgeon would be able to repair and preserve his own valve and not replace it with an artificial valve,” says Raj Janardhanan, MD, associate professor of medicine and medical imaging in the UA College of Medicine – Tucson, Division of Cardiology and an expert at detecting and evaluating valve disorders.

      “These tools just aren’t available in the Ajo clinic where my dad typically is seen,” says Jenna.

A normally functioning mitral valve in the heart ensures blood flows forward from the left atrium to the left ventricle. If the mitral valve becomes narrow and calcified (hardened), blood does not move forward with ease. This is called mitral stenosis. On the other hand, as in Terry’s case, if the valve does not close properly (leaks), blood may flow backward causing shortness of breath and heart failure. This is mitral regurgitation. Detecting these conditions now is easier with advanced 3D imaging techniques.

“What makes 3D-TEE critical in mitral valve problems is its unique ability to provide the surgeon a view of the mitral valve in the same orientation as he will see it once the chest is open. This helps in planning the surgical procedure. We can create 3D models of the valve. Thus, 3D imaging offers an improvement compared to routine 2D echocardiography,” says Dr. Janardhanan.

Symptoms of mitral valve problems typically include chronic cough, exhaustion, rapid breathing, rapid heartbeat, shortness of breath – especially with activity and when lying down – and excessive urination at night. Not all patients with valve disorders have symptoms. However, a doctor may detect a murmur, a galloping heart sound or crackles in the lungs. 

As Terry was nearing the end of his cardiac rehab program, his physical condition improved to the point that he traded his walker for a cane and is able to walk further, lift weights and cycle. He plans to continue his exercise program at the fitness center in Ajo. His next goal is to go on a cross-country car trip with his wife next spring.