We evaluated 147 patients with adequate color Doppler and angiographic studies for mitral regurgitation. Sixty-five patients had no mitral regurgitation by both color Doppler and angiography and 82 patients had mitral regurgitation by both techniques. Thus the sensitivity and specificity of color Doppler for the detection of mitral regurgitation was 100%. Materials and methodsThe original study consisted of 160 patients. However, 13 were excluded, eight because of poor acoustic window and inadequate echocardiographic images of the left atrium and five because of the presence of multiple premature ventricular contractions at the time of angiography, making the quantitation of mitral regurgitation impossible. Thus a total of 147 patients who had adequate color Doppler and angiographic examinations form the basis of this study. There were 79 men and 68 women, ranging in age from 17 to 84 years (mean 56). Eighty-two patients had mitral regurgitation by angiography, and the remaining 65 demonstrated normal mitral valvular function. The etiology of mitral regurgitation was ischemic heart disease in 34 rheumatic heart disease in 24, congestive cardiomyopathy in 13, and mitral valve prolapse in 11. Thirty-one of the 82 patients with mitral regurgitation were in atrial fibrillation and the remaining were in normal sinus rhythm. None of the patients without mitral regurgitation were in atrial fibrillation.

Background— Few data exist on the relation of the 3-dimensional morphology of mitral valve and degree of mitral regurgitation (MR) in mitral valve prolapse. Methods and Results— Real-time 3-dimensional transesophageal echocardiography of the mitral valve was acquired in 112 subjects, including 36 patients with mitral valve prolapse and significant MR (≥3+; MR+ group), 32 patients with mitral valve prolapse but no or mild MR (≤2+; MR− group), 12 patients with significant MR resulting from nonprolapse pathologies (nonprolapse group), and 32 control subjects. The 3-dimensional geometry of mitral valve apparatus was measured with dedicated quantification software. Compared with the normal and MR− groups, the MR+ group had more dilated mitral annulus ( P <0.0001), a reduced annular height to commissural width ratio (AHCWR) ( P <0.0001) indicating flattening of annular saddle shape, redundant leaflet surfaces ( P <0.0001), greater leaflet billow volume ( P <0.0001) and billow height ( P <0.0001), longer lengths from papillary muscles to coaptation ( P <0.0001), and more frequent chordal rupture ( P <0.0001). Prevalence of chordal rupture increased progressively with annulus flattening (7% versus 24% versus 42% for AHCWR >20%, 15%–20%, and <15%, respectively; P =0.004). Leaflet billow volume increased exponentially with decreasing AHCWR in patients without chordal rupture ( r 2 =0.66, P <0.0001). MR severity correlated strongly with leaflet billow volume ( r 2 =0.74, P <0.0001) and inversely with AHCWR ( r 2 =0.44, P <0.0001). In contrast, annulus dilatation but not flattening occurred in nonprolapse MR patients. An AHCWR <15% (odds ratio=7.1; P =0.0004) was strongly associated with significant MR in mitral valve prolapse. Conclusion— Flattening of the annular saddle shape is associated with progressive leaflet billowing and increased frequencies of chordal rupture and may be important in the pathogenesis of MR in mitral valve prolapse.

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.