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Implementation of real‐time three‐dimensional transesophageal echocardiography for mitral balloon valvuloplasty

Transthoracic (TTE) and intracardiac echocardiography (ICE) have both been established as modalities for imaging guidance in mitral balloon valvuloplasty (MBV). Real‐time three‐dimensional transesophageal echocardiography (RT3D‐TEE) improves depth resolution, characterization of pathology and visualization of interventional catheters and devices. Three‐dimensional imaging should enhance catheter navigation but improvements in procedural outcomes are not easily quantified. Using time from transseptal puncture to balloon inflation, procedure time and radiation exposure as surrogates for improvements linked to image guidance, we describe our early experience in implementing RT3D‐TEE during MBV, a prototypical left‐sided structural intervention.