Assessment of Aortic Regurgitation by Live Three‐Dimensional Transthoracic Echocardiographic Measurements of Vena Contracta Area: Usefulness and Validation

Abstract

In this report, we evaluate 56 consecutive adult patients who underwent standard two-dimensional (2D) and live three-dimensional transthoracic echocardiography (3D TTE), as well as left heart catheterization with aortography (45 patients) or cardiac surgery (11 patients), for evaluation of aortic insufficiency. Similar to the method we previously described for mitral insufficiency, aortic regurgitant vena contracta area (VCA) was obtained by 3D TTE by systematic and sequential cropping of the acquired 3D TTE data set. Assessments of aortic regurgitation (AR) by aortography and surgery are compared to measurements of VCA by 3D TTE and to 2D TTE measurements of vena contracta width (VCW). Aortographic or surgical grading correlated well with 2D TTE measurements of VCW (r = 0.92), but correlated better with 3D TTE measurements of VCA (r = 0.95), with improved dispersion between angiographic grades demonstrated by the 3D TTE technique. Live 3D TTE color Doppler measurements of VCA can be used for accurate assessment of AR and are comparable to assessment by aortography.

EAE/ASE Recommendations for Image Acquisition and Display Using Three-Dimensional Echocardiography

“…113 Three-dimensional echocardiographic color Doppler also allows visualization, and measurement of multiple jets were feasible and correlated morphologically with surgical findings. 113 However, the practical impact is limited, because this study used electrocardiographically gated 3D color flow imaging, whereas real-time volume color flow Doppler imaging is necessary to truly evaluate the feasibility and accuracy of quantification of aortic regurgitation in three dimensions. Three-dimensional TTE and TEE assessments of the aortic valve should be incorporated when available into the assessment of aortic stenosis and to elucidate the mechanism of aortic regurgitation.…”

Real-time three-dimensional echocardiographic evaluation of the mitral valve

“…3D color Doppler echocardiography is a useful tool in the visualization of the actual shape of the regurgitant orifi ce (vena contracta area) [22][23][24][25]. Khanna et al [22] investigated the accuracy of the vena contracta area measurements by live 3D color Doppler echocardiography in mitral regurgitation.…”

Valvular heart disease – insufficiencies

“…Several studies demonstrated the advantage of using 3D TTE datasets to optimally identify a cross-sectional plane through the vena contracta perpendicular to the aor tic regurgitant flow [108,109]. Using angiographic grading for reference, Fang et al [108] found good agreement for 3D vena contracta area measurements with aortic regurgitation severity grades and proposed a vena contracta area of <20 mm 2 and >60 mm 2 to define mild and severe aortic regurgitation, which has also been referenced in recent guidelines [11]. In a study with similar design, Chin et al [109] also found good agreement of 3D vena contracta measurements with angiographic grading and derived a cutoff value for VCA of <30 mm 2 predicting mild aortic regurgitation and >50 mm 2 for predicting severe aortic regurgitation.…”