3D Echocardiography for Rheumatic Heart Disease Analysis: Ready for Prime Time

Abstract

Rheumatic heart disease (RHD) remains to be a very important health issue worldwide, mainly in underdeveloped countries. It continues to be a leading cause of morbidity and mortality throughout developing countries. RHD is a delayed non-suppurative immunologically mediated inflammatory response to the throat infection caused by a hemolytic streptococcus from the A group (Streptococcus pyogenes). RHD keeps position 1 as the most common cardiovascular disease in young people aged <25 years considering all the continents. The disease can lead to valvular cardiac lesions as well as to carditis. Rheumatic fever valvular injuries lead most commonly to the fusion and thickening of the edges of the cusps and to the fusion, thickening, and shortening of the chordae and ultimately to calcification of the valves. Valvular commissures can also be deeply compromised, leading to severe stenosis. Atrial and ventricular remodeling is also common following rheumatic infection. Mixed valvular lesions are more common than isolated valvular disorders. Echocardiography is the most relevant imaging technique not only to provide diagnostic information but also to enable prognostic data. Further, it presents a very important role for the correction of complications after surgical repair of rheumatic heart valvulopathies. Three-dimensional (3D) echocardiography provides additional anatomical and morphofunctional information of utmost importance for patients presenting rheumatic valvopathies. Accordingly, three-dimensional echocardiography is ready for routine use in patients with RHD presenting with valvular abnormalities.

Mitral Valve Area Quantification Using Digital Image Processing: Is That Feasible?

“…7,8 Echocardiography is an essential diagnostic tool in the recognition and determination of the extent of cardiac involvement in rheumatic disease, especially in mitral valve dysfunction, by demonstrating typical findings such as reduced mobility due to leaflet thickening, commissural fusion, involvement of the subvalvular apparatus (shortening, thickening and fusion of the chordae tendineae) and valve and annulus calcification. [7][8][9] The progressive reduction of the valve area is accompanied by a gradual increase in left atrial pressure, pulmonary venous pressure and the onset of more common symptoms such as dyspnea. [7][8][9] The grading of mitral stenosis requires careful valve morphofunctional evaluation, as well as an accurate analysis of associated pathologies due to the implications in the therapeutic decision and the choice from different types of intervention (percutaneous or surgical approach in its multiple possibilities).…”

“…[7][8][9] The progressive reduction of the valve area is accompanied by a gradual increase in left atrial pressure, pulmonary venous pressure and the onset of more common symptoms such as dyspnea. [7][8][9] The grading of mitral stenosis requires careful valve morphofunctional evaluation, as well as an accurate analysis of associated pathologies due to the implications in the therapeutic decision and the choice from different types of intervention (percutaneous or surgical approach in its multiple possibilities). [7][8][9] Echocardiography is the first-line imaging technique for analyzing the mitral valve, offering numerous advantages over other analysis techniques (real-time analysis, devoid of radiation, based on three-dimensional projections, low cost, widely available); however, it has limitations, such as the great dependence on the quality of the acquired image, dependence on the cardiologist's experience during the acquisition and interpretation of images, especially in the three-dimensional study, which requires additional training and experience, for better multiplanar reconstruction of cardiac structures.…”

“…Realtime three-dimensional echocardiography shows the leaflets in multiple planes, providing a more accurate identification of the most anatomical opening of the mitral valve. [7][8][9] Evaluation of valve segmentation, important in minimally invasive structural cardiac intervention, showed great progress in recent years, due to the applicability of AI to cardiovascular imaging tests. 4,9 This AI analysis of the mitral valve apparatus has evolved rapidly over the last few years, from the analysis that required many steps for its final elaboration to the semiautomatic, rapid and very expressive analysis of the mitral valve anatomy.…”

“…[7][8][9] Evaluation of valve segmentation, important in minimally invasive structural cardiac intervention, showed great progress in recent years, due to the applicability of AI to cardiovascular imaging tests. 4,9 This AI analysis of the mitral valve apparatus has evolved rapidly over the last few years, from the analysis that required many steps for its final elaboration to the semiautomatic, rapid and very expressive analysis of the mitral valve anatomy. 4,9 We are currently working on a project for the rapid semiquantitative analysis of the surgical results of patients with mitral valve disease due to fibroelastic etiology and valve prolapse, with pre and post-operative analysis after double teflon repair.…”

“…4,9 This AI analysis of the mitral valve apparatus has evolved rapidly over the last few years, from the analysis that required many steps for its final elaboration to the semiautomatic, rapid and very expressive analysis of the mitral valve anatomy. 4,9 We are currently working on a project for the rapid semiquantitative analysis of the surgical results of patients with mitral valve disease due to fibroelastic etiology and valve prolapse, with pre and post-operative analysis after double teflon repair. This analysis shows the observation of more than 30 elements that constitute the mitral valve apparatus.…”