Geometry of the proximal isovelocity surface area in mitral regurgitation by 3-dimensional color Doppler echocardiography: Difference between functional mitral regurgitation and prolapse regurgitation

Matsumura, Yoshiki; Fukuda, Shota; Tran, Hung D.; Greenberg, Neil L.; Agler, Deborah A.; Wada, Nozomi; Toyono, Manatomo; Thomas, James D.; Shiota, Takahiro

doi:10.1016/j.ahj.2007.09.002

Cited by 129 publications

(86 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Therefore, the near-hemispherical shell must first be identified before measuring PISA radius, which at times is difficult to perform. It is known from 3D studies (17,22) that the orifice is often not circular but frequently hemiellipsoidal or even irregularly shaped. It is known from previous studies (26,36) that the application of the PISA method for estimation of severity of MR is feasible in an optimal isovelocity zone.…”

Section: Discussionmentioning

confidence: 99%

A three-dimensional insight into the complexity of flow convergence in mitral regurgitation: adjunctive benefit of anatomic regurgitant orifice area

Chandra

Salgo

Sugeng

et al. 2011

American Journal of Physiology-Heart and Circulatory Physiology

View full text Add to dashboard Cite

Chandra S, Salgo IS, Sugeng L, Weinert L, Settlemier SH, Mor-Avi V, Lang RM. A three-dimensional insight into the complexity of flow convergence in mitral regurgitation: adjunctive benefit of anatomic regurgitant orifice area. Am J Physiol Heart Circ Physiol 301: H1015-H1024, 2011. First published June 17, 2011 doi:10.1152/ajpheart.00275.2011.-Mitral effective regurgitant orifice area (EROA) using the flow convergence (FC) method is used to quantify the severity of mitral regurgitation (MR). However, it is challenging and prone to interobserver variability in complex valvular pathology. We hypothesized that real-time three-dimensional (3D) transesophageal echocardiography (RT3D TEE) derived anatomic regurgitant orifice area (AROA) can be a reasonable adjunct, irrespective of valvular geometry. Our goals were to 1) to determine the regurgitant orifice morphology and distance suitable for FC measurement using 3D computational flow dynamics and finite element analysis (FEA), and (2) to measure AROA from RT3D TEE and compare it with 2D FC derived EROA measurements. We studied 61 patients. EROA was calculated from 2D TEE images using the 2D-FC technique, and AROA was obtained from zoomed RT3DE TEE acquisitions using prototype software. 3D computational fluid dynamics by FEA were applied to 3D TEE images to determine the effects of mitral valve (MV) orifice geometry on FC pattern. 3D FEA analysis revealed that a central regurgitant orifice is suitable for FC measurements at an optimal distance from the orifice but complex MV orifice resulting in eccentric jets yielded nonaxisymmetric isovelocity contours close to the orifice where the assumptions underlying FC are problematic. EROA and AROA measurements correlated well (r ϭ 0.81) with a nonsignificant bias. However, in patients with eccentric MR, the bias was larger than in central MR. Intermeasurement variability was higher for the 2D FC technique than for RT3DE-based measurements. With its superior reproducibility, 3D analysis of the AROA is a useful alternative to quantify MR when 2D FC measurements are challenging.three-dimensional echocardiography; Doppler echocardiography; mitral valve; proximal isovelocity surface area TWO-AND THREE-DIMENSIONAL (2D and 3D) echocardiography combined with Doppler interrogation plays a crucial role in the identification of the mechanisms, in the accurate quantification of the severity of mitral regurgitation (MR), and in the assessment of the suitability for repair. The severity of MR has been used to determine the progression of disease (9), identify patients at the highest mortality risk without surgical intervention, (8,13,14,16,20, 33), and guide the timing of surgery (4,23,32,35). Effective regurgitant orifice area (EROA) based on 2D methods of flow convergence (FC) estimation is currently one of the standards used to assess the severity of MR.Unlike 2D planimetry of mitral and aortic stenotic valves, planimetry of the regurgitant orifice area in patients with MR is not feasible because of the complex, nonplanar 3D geometry ...

show abstract

Section: Discussionmentioning

confidence: 99%

A three-dimensional insight into the complexity of flow convergence in mitral regurgitation: adjunctive benefit of anatomic regurgitant orifice area

Chandra

Salgo

Sugeng

et al. 2011

American Journal of Physiology-Heart and Circulatory Physiology

View full text Add to dashboard Cite

show abstract

“…The latter is specifically important in patients with functional MR where the regurgitant orifice is thought to be largest at the beginning and end of systole and smallest in the middle. 10,13 Although previous studies have shown that 3D methods are more accurate than 2D PISA methods for MR quantification, these studies either required significant manual interaction with the data or ongoing geometric assumptions [5][6][7][8][9] and were unable to account for the dynamic nature of the regurgitant orifice. [5][6][7][8][9]12 In this study, the 3D PISA was measured in an automated method without making any specific geometric assumptions.…”

Section: Automated 3d Pisa-based Eroa and Rvolmentioning

confidence: 99%

“…3,4 Although 3-dimensional (3D) echocardiography-based PISA techniques have been shown to be more accurate, [5][6][7][8][9] it is not widely used because of limitations of gated acquisitions, the need for time-consuming manual interaction with the data, and ongoing need for shape assumptions. Also, current 3D PISA techniques do not account for the dynamic nature of the regurgitant orifice, which is especially important in functional MR.…”

mentioning

confidence: 99%

Quantification of Chronic Functional Mitral Regurgitation by Automated 3-Dimensional Peak and Integrated Proximal Isovelocity Surface Area and Stroke Volume Techniques Using Real-Time 3-Dimensional Volume Color Doppler Echocardiography

Thavendiranathan

Liu

Datta

et al. 2013

Circ: Cardiovascular Imaging

120

View full text Add to dashboard Cite

Background-The aim of this study was to test the accuracy of an automated 3-dimensional (3D) proximal isovelocity surface area (PISA) (in vitro and patients) and stroke volume technique (patients) to assess mitral regurgitation (MR) severity using real-time volume color flow Doppler transthoracic echocardiography. Methods and Results-Using an in vitro model of MR, the effective regurgitant orifice area and regurgitant volume (RVol) were measured by the PISA technique using 2-dimensional (2D) and 3D (automated true 3D PISA) transthoracic echocardiography. The mean anatomic regurgitant orifice area (0.35±0.10 cm 2 ) was underestimated to a greater degree by the 2D (0.12±0.05 cm 2 ) than the 3D method (0.25±0.10 cm 2 ; P<0.001 for both). Compared with the flowmeter (40±14 mL), the RVol by 2D PISA (20±19 mL) was underestimated (P<0.001), but the 3D peak (43±16 mL) and integrated PISA-based (38±14 mL) RVol were comparable (P>0.05 for both). In patients (n=30, functional MR), 3D effective regurgitant orifice area correlated well with cardiac magnetic resonance imaging RVol r=0.84 and regurgitant fraction r=0.80. Compared with cardiac magnetic resonance imaging RVol (33±22 mL), the integrated PISA RVol (34±26 mL; P=0.42) was not significantly different; however, the peak PISA RVol was higher (48±27 mL; P<0.001). In addition, RVol calculated as the difference in automated mitral and aortic stroke volumes by real-time 3D volume color flow Doppler echocardiography was not significantly different from cardiac magnetic resonance imaging (34±21 versus 33±22 mL; P=0.33). Conclusions-Automated real-time 3D volume color flow Doppler based 3D PISA is more accurate than the 2D PISA method to quantify MR. In patients with functional MR, the 3D RVol by integrated PISA is more accurate than a peak PISA technique. Automated 3D stroke volume measurement can also be used as an adjunctive method to quantify MR severity. (Circ Cardiovasc Imaging. 2013;6:125-133.)Key Words: 3D integrated PISA ◼ 3D peak PISA ◼ automated 3D stroke volume ◼ cardiac MR imaging ◼ mitral regurgitation ◼ real-time 3D volume color flow Doppler echocardiography

show abstract

“…It can also appear to be rather elongated along the mitral coaptation line and noncircular. 12,24 Thus, the orifice shape of functional MR seems to have asymmetrical rather than symmetrical. In our study, mean ratio of vena contracta from apical 2-chamber view/apical 4-chamber view was 1.17 in organic MR and 1.89 in functional MR.…”

Section: Subgroup Analysis Of Mr Volume According To the Severity Andmentioning

confidence: 99%

Differential Effect of 3-Dimensional Color Doppler Echocardiography for the Quantification of Mitral Regurgitation According to the Severity and Characteristics

Choi

Heo

Hong

et al. 2014

Circ: Cardiovascular Imaging

View full text Add to dashboard Cite

Although the flow quantification using 3D-CDE has been proposed to overcome the inherent limitations of 2D-CDE, 9,12-15 its technical limitations, such as multiple gated acquisition and time-consuming manual processing, prevent it from becoming widely adopted into daily clinical practice.Recently, advances in technology of 3D-CDE provide the option of semiautomated MR quantification based on the 3D-PISA method, and its results could be potentially more accurate than 2D-PISA method in quantifying MR. 16Background-The aim of this study is to explore the differential effect of 3-dimensional color Doppler echocardiography for the quantification of mitral regurgitation (MR

show abstract

Geometry of the proximal isovelocity surface area in mitral regurgitation by 3-dimensional color Doppler echocardiography: Difference between functional mitral regurgitation and prolapse regurgitation

Cited by 129 publications

References 26 publications

A three-dimensional insight into the complexity of flow convergence in mitral regurgitation: adjunctive benefit of anatomic regurgitant orifice area

A three-dimensional insight into the complexity of flow convergence in mitral regurgitation: adjunctive benefit of anatomic regurgitant orifice area

Quantification of Chronic Functional Mitral Regurgitation by Automated 3-Dimensional Peak and Integrated Proximal Isovelocity Surface Area and Stroke Volume Techniques Using Real-Time 3-Dimensional Volume Color Doppler Echocardiography

Differential Effect of 3-Dimensional Color Doppler Echocardiography for the Quantification of Mitral Regurgitation According to the Severity and Characteristics

Contact Info

Product

Resources

About