Three-dimensional echocardiographic planimetry of maximal regurgitant orifice area in myxomatous mitral regurgitation: intraoperative comparison with proximal flow convergence

Breburda, Christian S.; Griffin, Brian P.; Pu, Min; Rodriguez, L. Leonardo; Cosgrove, Delos M.; Thomas, James D.

doi:10.1016/s0735-1097(98)00239-3

Cited by 53 publications

(31 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This probably reflects the physical differences between the two methods. The potential advantage of the AROA technique is that it directly measures the true anatomic orifice in 3D, whereas the FC method is not only subject to orifice geometry and flow but also relies on the quantification of the narrowest flow emerging from the orifice, which is expected to be smaller by the coefficient of contraction (5). In contrast, the 3D measurements of AROA can be expected to be less affected by these constraints and thus be less prone to intermeasurement variability even in degenerative MV disease with eccentric regurgitant jets (3).…”

Section: Discussionmentioning

confidence: 99%

“…In a previous study (5), 3D planimetry of the regurgitant orifice area was applied to a single cut-plane extracted from 3D-reconstructed multiplane TEE data sets, demonstrating high correlation with FC measurements but with a negative bias. These results could be explained by the underestimation of the complexity of the 3D geometry of the regurgitant orifice.…”

Section: Discussionmentioning

confidence: 99%

“…Images were reviewed and analyzed offline on an Xcelera workstation (Philips Healthcare). For any regurgitant orifice resulting in either central or eccentric jet, flow in the proximal FC zone was calculated by using previously described methodology (5,24,37). In the presence of multiple MR jets, PISA measurements were attempted on both jets, which was feasible usually in the largest visualized jet.…”

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

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%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

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 AROA >25 mm 2 obtained from the LA view of the reconstructed mitral valve had 99% sensitivity and 88% specificity in distinguishing mid (1+ to 2+) from moderately severe mitral regurgitation (3+ to 4+) [84]. The measurements of AROA correlates well with PISA derived EROA quantification of MR severity [84,85]. In addition the AROA can be obtained and accurately predict severity of mitral regurgitation even in patients with atrial fibrillation, where beat to beat regurgitant volumes vary significantly [84].…”

Section: Planimetrymentioning

confidence: 76%

Quantitative assessment of mitral insufficiency: Its advantages and disadvantages

Paszczuk

Wiegers

2006

Heart Fail Rev

View full text Add to dashboard Cite

“…With the ability to combine 3D color flow with gray-scale information, it became possible to detect the origin and direction of jets, paravalvular leaks, and multiple jets, and to measure the dimension of the vena contracta and regurgitant orifice areas [57,58]. However, several issues continue to hamper the use of 3D color flow imaging, including: 1) reliance on acquisition of multiple cardiac cycles that may result in stitch artifacts; 2) limited sector angle that may not allow complete visualization of eccentric jets; and 3) compromised visualization of 3D gray-scale information when acquired simultaneously with color.…”

Section: Valvular Heart Diseasementioning

confidence: 99%

Three-dimensional adult echocardiography: Where the hidden dimension helps

Mor‐Avi

Sugeng²,

Lang³

2008

Curr Cardiol Rep

View full text Add to dashboard Cite

The introduction of three-dimensional (3D) imaging and its evolution from slow and labor-intense off-line reconstruction to real-time volumetric imaging is one of the most significant developments in ultrasound imaging of the heart of the past decade. This imaging modality currently provides valuable clinical information that empowers echocardiography with new levels of confidence in diagnosing heart disease. One major advantage of seeing the additional dimension is the improvement in the accuracy of the evaluation of cardiac chamber volumes by eliminating geometric modeling and the errors caused by foreshortened views. Another benefit of 3D imaging is the realistic views of cardiac valves capable of demonstrating numerous pathologies in a unique, noninvasive manner. This article reviews the major technological developments in 3D echocardiography and some of the recent literature that has provided the scientific basis for its clinical use.

show abstract

Three-dimensional echocardiographic planimetry of maximal regurgitant orifice area in myxomatous mitral regurgitation: intraoperative comparison with proximal flow convergence

Abstract: 3D echo imaging of the MV allows direct visualization and planimetry of the ROA in patients with severe MR with good agreement to flow-based proximal convergence measurements.

Cited by 53 publications

References 33 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

Quantitative assessment of mitral insufficiency: Its advantages and disadvantages

Three-dimensional adult echocardiography: Where the hidden dimension helps

Contact Info

Product

Resources

About