A Novel Approach to Assess the Three-Dimensional Anatomy of a Mitral Valve Regurgitant Jet Orifice

Cobey, Frederick C.; Ferreira, Renata G.; Ursprung, W. W. Sanouri A.; Karhausen, Joern; Swaminathan, Madhav; Mackensen, G. Burkhard

doi:10.1053/j.jvca.2016.09.007

Cited by 6 publications

(3 citation statements)

References 18 publications

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“…Not depending on geometric assumptions, AROA is a robust parameter, even in non-circular or multiple regurgitation orifices. We showed that AROA exhibits a good correlation with 3D VCA, which is in line with several previous studies [ 17 , 18 ]. However, the absolute differences in the comparison methods varied between the studies, which is likely due to different measurement methods.…”

Section: Discussionsupporting

confidence: 93%

Benefit of 3D Vena Contracta Area over 2D-Based Echocardiographic Methods in Quantification of Functional Mitral Valve Regurgitation

et al. 2023

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Background: The two-dimensional proximal isovelocity surface area (2D PISA) method in the quantification of an effective regurgitation orifice area (EROA) has limitations in functional mitral valve regurgitation (FMR), particularly in non-circular coaptation defects. Objective: We aimed to validate a three-dimensional vena contracta area (3D VCA) against a conventional EROA using a 2D PISA method and anatomic regurgitation orifice area (AROA) in patients with FMR. Methods: Both 2D and 3D full-volume color Doppler data were acquired during consecutive transoesophageal echocardiography (TEE) examinations. The EROA 2D PISA was calculated as recommended by current guidelines. Multiplanar reconstruction was used for offline analysis of the 3D VCA (with a color Doppler) and AROA (without a color Doppler). Receiver operating characteristic (ROC) analysis was used to calculate a cut-off value for the 3D VCA to discriminate between moderate and severe FMR as classified by the EROA 2D PISA. Results: From 2015 to 2018, 105 consecutive patients with complete and adequate imaging data were included. The 3D VCA correlated strongly with the 2D PISA EROA and AROA (r = 0.93 and 0.94). In the presence of eccentric or multiple regurgitant jets, there was no significant difference in correlations with the 3D VCA. We found a 3D VCA cut-off of 0.43 cm2 to discriminate between moderate and severe FMR (area under curve = 0.98). The 3D VCA showed a higher interobserver agreement than the EROA 2D PISA (interclass correlation coefficient: 0.94 vs. 0.81). Conclusions: The 3D VCA has excellent validity and lower variability than the conventional 2D PISA in FMR. Compared to the 2D PISA, the 3D VCA was not affected by the presence of eccentric or multiple regurgitation jets or non-circular regurgitation orifices. With a threshold of 0.43 cm2 for the 3D VCA, we demonstrated reliable discrimination between moderate and severe FMR.

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Section: Discussionsupporting

confidence: 93%

Benefit of 3D Vena Contracta Area over 2D-Based Echocardiographic Methods in Quantification of Functional Mitral Valve Regurgitation

et al. 2023

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“…This approach is considered the most reliable although it calculates MR from a difference, rather than directly on the mitral valve (MV), presenting some degree of variability 17 . The effective orifice area (EOA) 8,13,14 represents a more structural measure of MV insufficiency; this approach also presents various limitations 3 partly imputable to the difficulty of measuring the EOA directly from images of the MV orifice (MVO).…”

Section: Introductionmentioning

confidence: 99%

Analysis of mitral valve regurgitation by computational fluid dynamics

2019

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The clinical syndrome of mitral insufficiency is a common consequence of mitral valve (MV) prolapse, when the MV leaflets do not seal the closed orifice and blood regurgitates back to the atrium during ventricular contraction. There are different types of MV prolapse that may influence the degree of regurgitation also in relation to the left ventricle (LV) geometry. This study aims to provide some insight into the fluid dynamics of MV insufficiency in view of improving the different measurements available in the clinical setting. The analysis is performed by a computational fluid dynamics model coupled with an asymptotic model of the MV motion. The computational fluid dynamics solution uses the immersed boundary method that is efficiently integrated with clinical imaging technologies. Healthy and dilated LVs obtained by multislice cardiac MRI are combined with simplified models of healthy and pathological MVs deduced from computed tomography and 4D-transesophageal echocardiography. The results demonstrated the properties of false regurgitation, blood that did not cross the open MV orifice and returns into the atrium during the backward motion of the MV leaflets, whose entity should be accounted when evaluating small regurgitation. The regurgitating volume is found to be proportional to the effective orifice area, with the limited dependence of the LV geometry and type of prolapse. These affect the percentage of old blood returning to the atrium which may be associated with thrombogenic risk.

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“…Instead, it is the essential moment to carefully assess the pathoanatomy of the lesion(s) and to identify anatomic risk factors that should be avoided in tailoring the correct repair solution for each individual patient by using all means necessary. 2,3,13,17-19 This exercise, most commonly performed by the echo-boarded cardiac anesthesiologist, should not focus on the obvious lesion such as a P2 flail, but on identifying the potential secondary mechanisms that could be masked by an obvious lesion. After a thorough 2-dimensional assessment where the majority of these features can be identified, 3-dimensional (3D) reconstruction with/without color flow may clarify or confirm potential subtle surgical pitfalls.…”

Section: Pathoanatomic Assessmentmentioning

confidence: 99%