Quantification of mitral valve apparatus by three-dimensional transesophageal echocardiography: in vitro validation study comparing two different analysis systems

Saito, Ken; Okura, Hiroyuki; Watanabe, Nozomi; Imai, Kyoichi; Tamada, Tomoko; Koyama, Terumasa; Hayashida, Akihiro; Neishi, Yoji; Kawamoto, Takahiro; Yoshida, Kiyoshi

doi:10.1007/s12574-011-0091-z

Cited by 4 publications

(3 citation statements)

References 32 publications

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“…The current study reveals unique information that 3D echocardiography can provide, showing the use of 3D echocardiography to investigate pathophysiology of MV disease. 12,19,20,31 …”

Section: Discussionmentioning

confidence: 99%

Evidence of a Vicious Cycle in Mitral Regurgitation With Prolapse

et al. 2012

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Background-In patients with mitral valve prolapse, nonprolapsed leaflets are often apically tented. We hypothesized that secondary left ventricular dilatation attributed to primary mitral regurgitation (MR) causes papillary muscle (PM) displacement, resulting in this leaflet tenting/tethering, and that secondary tethering further exacerbates malcoaptation and contributes to MR severity. Methods and Results-Three-dimensional transesophageal echocardiography was performed in 25 patients with posterior mitral leaflet prolapse with an intact anterior mitral leaflet (AML) and 20 controls. From 3D zoom data sets, 11 equidistant antero-posterior cut planes of the mitral valve at midsystole were obtained. In each plane, tenting area of nonprolapsed leaflet and prolapse area of prolapsed leaflet were measured. Prolapse/tenting volume of each region was obtained as the product of interslice distance and the prolapse/tenting area. AML tenting volume and whole leaflet prolapse/tenting volume were then obtained. The PM tethering distance between PM tips and anterior mitral annulus was measured from 3D full-volume data sets. The severity of MR was quantified by vena contracta area extracted from color 3D transesophageal echocardiography data sets. AML tenting volume was significantly larger in patients with posterior mitral leaflet prolapse compared with that in controls (1.2Ϯ0.5 versus 0.6Ϯ0.2 mL/m 2 ; PϽ0.001). Multivariate regression analysis identified independent contribution to AML tenting volume from an increase in PM tethering distance. Multivariate regression analysis identified independent contributions to MR severity (vena contracta area) from both whole leaflet tenting volume (rϭ0.

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“…The current study reveals unique information that 3D echocardiography can provide, showing the use of 3D echocardiography to investigate pathophysiology of MV disease. 12,19,20,31 …”

Section: Discussionmentioning

confidence: 99%

Evidence of a Vicious Cycle in Mitral Regurgitation With Prolapse

et al. 2012

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“…In the final screen, different layouts of the mitral valve can be demonstrated (2D views, volume rendering en face view and MV model) along with all the measurements for the annulus and the leaflets (Figure 1, Video S1). (11) It needs to be mentioned that by inserting the landmarks into the protocol, we can only create the MV model. The system then automatically defines each echocardiographic parameter without the ability to be corrected from the user.…”

Section: D Transthoracic and Transesophageal Echocardiographic Datamentioning

confidence: 99%

“…(1) 2D & 3D annulus area, (2) annulus perimeter, (3) anterior-posterior diameter, (4) medial-lateral diameter, (5) commissural diameter, (6) inter-trigonal diameter, (7) aorto-mitral angle, (8) anterior leaflet area, (9) posterior leaflet area, (10) anterior leaflet length, (11) posterior leaflet length, (12) tenting height, (13) tenting area, and (14) tenting volume.…”

Section: D Transthoracic and Transesophageal Echocardiographic Datamentioning

confidence: 99%

Level of agreement between three‐dimensional transthoracic and transesophageal echocardiography for mitral annulus evaluation: A feasibility and comparison study

et al. 2022

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Introduction: Mitral annulus assessment is of utmost importance for the management of patients with mitral valve (MV) abnormalities, as it helps to determine the decision for surgical or transcatheter treatment. Three-dimensional (3D) transesophageal echocardiography (TOE) has been the only reliable echocardiographic method for the evaluation of the mitral annulus by now. However, newer transthoracic echocardiography (TTE) 3D probes have enabled to provide accurate measurements as well and become a valuable tool when TOE is contraindicated. The aim of this study is to assess the feasibility of 3D TTE analysis of mitral annulus and the level of agreement with 3D TOE measurements.Methods: A total of 121 consecutive patients were assessed with 3D TTE and TOE.All mitral annulus parameters were retrospectively analyzed with the dedicated 4D autoMVQ application. Bland-Altman analysis and intraclass correlation coefficient were used for the comparison and agreement between the two methods. Half of our patients had normal mitral valves and served as control group, while the other half had various mitral valve pathologies.Results: AutoMVQ analysis was not feasible in 11 out of 121 TTE examinations (91% feasibility) and in 4 out of 121 TOE examinations (96% feasibility). Mitral annular area and perimeter were slightly larger in TTE than those measured by TOE (12.7 ± 3.6 vs.12.4 ± 3.2 cm 2 for area and 12.7 ± 1.7 vs. 12.5 ± 1.6 cm for perimeter), however still showing strong correlation (r = .942 and r = .922, respectively). The majority of mitral valve measurements (anterior-posterior, medial-lateral and commissural diameter, aorto-mitral angle and anterior leaflet length) were similar among the two methods with strong correlation (r > .80). Inter-trigonal distance, posterior leaflet length and tenting height showed weaker agreement between TTE and TOE (r = .687, r = .687, r = .634, respectively). Mitral annular dimensions (by 3D area) were found to be significantly larger in patients with MV pathology (13.5 ± 3.5 vs. 11 ± 2.3 cm 2 ), atrial fibrillation (14.4 ± 3 vs. 11.4 ± 2.8 cm 2 ), left ventricular (13.8 ± 3.1 vs. 11.7 ± 3.1cm 2 ) and left atrial dilatation (13 ± 3.3 vs. 10.6 ± 2.3cm 2 ) compared to the individuals in the control group (p < .001 for all comparisons).

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