Determination of Regurgitant Orifice Area with the Use of a New Three-Dimensional Flow Convergence Geometric Assumption in Functional Mitral Regurgitation

Matsumura, Yoshiki; Saracino, Giuseppe; Sugioka, Kenichi; Tran, Hung D.; Greenberg, Neil L.; Wada, Nozomi; Toyono, Manatomo; Fukuda, Shota; Hozumi, Takeshi; Thomas, James D.; Yoshikawa, Junichi; Yoshiyama, Minoru; Shiota, Takahiro

doi:10.1016/j.echo.2008.09.004

Cited by 79 publications

(42 citation statements)

References 20 publications

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“…The relatively smaller EROA by 2D compared with 3D method is likely because of greater underestimation of EROA for 2 large asymmetrical orifices by 2D PISA and the errors in 2D PISA radius measurements because of the challenges in identifying the center of the regurgitant orifices particularly in the in vitro model. Also similar to previous 2D studies 10 but different from all previous 3D PISA publications, [5][6][7][8][9]12 this study compared the use of 3D peak and integrated PISA methods to quantify MR RVol. In the in vitro model, the RVol by the 3D peak and integrated PISA methods was accurate, whereas the 2D RVol was underestimated by 50%.…”

Section: Automated 3d Pisa-based Eroa and Rvolsupporting

confidence: 51%

“…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.…”

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confidence: 99%

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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

126

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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

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Section: Automated 3d Pisa-based Eroa and Rvolsupporting

confidence: 51%

Section: Automated 3d Pisa-based Eroa and Rvolmentioning

confidence: 99%

mentioning

confidence: 99%

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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

126

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“…4 On the other hand, a broad spectrum of irregularly shaped EROA is often found in patients with organic mitral valve disease. 6,7,20 Considering the ability of 3D color Doppler echocardiography to directly image the EROA without the assumption of rotational symmetry, this technique may be more accurate than 2D echocardiography for quantification of mitral regurgitation. Several in vitro and in vivo studies have compared the accuracy of 2D and 3D color Doppler techniques to quantify mitral regurgitant volume against reference methods (flowmeter standard and MRI).…”

Section: Quantification Of Mitral Regurgitation Using 2d Versus 3d Teementioning

confidence: 99%

Quantitative Assessment of Mitral Regurgitation

Shanks

Siebelink

Delgado

et al. 2010

Circ: Cardiovascular Imaging

128

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Background-Quantification of mitral regurgitation severity with 2-dimensional (2D) imaging techniques remains challenging. The present study compared the accuracy of 2D transesophageal echocardiography (TEE) and 3-dimensional (3D) TEE for quantification of mitral regurgitation, using MRI as the reference method. Methods and Results-Two-dimensional and 3D TEE and cardiac MRI were performed in 30 patients with mitral regurgitation.Mitral effective regurgitant orifice area (EROA) and regurgitant volume (Rvol) were estimated with 2D and 3D TEE. With 3D TEE, EROA was calculated using planimetry of the color Doppler flow from en face views and Rvol was derived by multiplying the EROA by the velocity time integral of the regurgitant jet. Finally, using MRI, mitral Rvol was quantified by subtracting the aortic flow volume from left ventricular stroke volume. Compared with 3D TEE, 2D TEE underestimated the EROA by a mean of 0.13 cm

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“…28 Studies have shown that estimates of effective regurgitant orifice area are more accurate when an elliptical-based formula is used to calculate effective regurgitant orifice area rather than a hemispheric-based one. 28,29 In fact, when fluid dynamic modeling is used, the shape of the flow convergence shell close to an irregular, nonplanar orifice results in an asymmetrical isovelocity shell, whereas farther from the orifice, it becomes more hemispheric. 30 This implies that although the proximal isovelocity surface area may appear symmetrical on single cut-plane 2D image, because of the hemispheric assumptions in the calculation, the accuracy of a proximal isovelocity surface area measurement derived from this image would be highly dependent on the distance of the measured radius from the regurgitant orifice.…”

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confidence: 99%

Three-dimensional Echocardiography Is Essential for Intraoperative Assessment of Mitral Regurgitation

Tsang

Lang²

2013

Circulation

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Since its introduction, 3-dimensional (3D) transesophageal echocardiography (TEE) has become widely adopted in operating rooms and cardiac catheterization laboratories worldwide. This is because the matrix-array 3D TEE probe allows acquisition of high-quality 3D images in real time with relatively little training. The rapid adoption of this technology has proven that this innovative imaging modality provides additional clinical information beyond that obtained from 2-dimensional (2D) TEE images. These developments have enabled medical centers to create integrated valve programs in which surgeons, interventionalists, and echocardiographers discuss cases and surgical approaches. Response by McCarthy on p 652In particular, 3D TEE has been proven to be superior to 2D TEE in the assessment of both mitral valve anatomy and mitral regurgitation, promoting its use in the operating room (Table 1). [1][2][3] One reason for this superiority is that 3D TEE allows the mitral valve to be displayed en face in an orientation identical to the surgeon's view of the mitral valve intraoperatively. This surgeon's view greatly facilitates communication with cardiac surgeons because they can easily interpret these images.Here, we argue that the widespread acceptance and use of 3D TEE are attributable to the pivotal role this modality plays in the intraoperative assessment of mitral regurgitation. We believe that 3D TEE of the mitral valve is invaluable not only because of the realistic images it provides but also because it improves: 1) lesion localization, 2) identification of the mechanisms causing mitral regurgitation, 3) quantification of the severity of mitral regurgitation, 4) selection of surgical intervention, 5) the choice of the surgeon whose expertise is best suited to perform the operation, 6) guidance of percutaneous mitral valve procedures, and 7) postoperative assessment. 3D Echocardiography of the Mitral ValveAccurate preoperative assessment of the mitral valve is critical in the surgical management of patients with severe mitral regurgitation. This information determines whether the patient should undergo valve repair or replacement, which has implications in terms of timing of surgery and long-term morbidity and mortality. 4 Traditionally, 2D TEE has been used to evaluate mitral valve anatomy. However, 2D TEE requires manual manipulation of the transducer in the esophagus and various degrees of flexion or anteflexion of the probe to acquire the standard mid-esophageal views and to examine all leaflet scallops. Since 2D TEE only provides single plane images, the entire mitral annulus and leaflets are not displayed in a single en face view, making it difficult to identify specific scallops with precision. As well, because the mitral annulus is saddle shaped, distortions of mitral valve anatomy, mitral annular dilatation, or aortic root enlargement may change the orientation of the ultrasound plane in relation to mitral valve apparatus, resulting in scallop misidentification.

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Determination of Regurgitant Orifice Area with the Use of a New Three-Dimensional Flow Convergence Geometric Assumption in Functional Mitral Regurgitation

Cited by 79 publications

References 20 publications

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

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

Quantitative Assessment of Mitral Regurgitation

Three-dimensional Echocardiography Is Essential for Intraoperative Assessment of Mitral Regurgitation

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