Direct Measurement of Vena Contracta Area by Real-Time 3-Dimensional Echocardiography for Assessing Severity of Mitral Regurgitation

Yosefy, Chaim; Hung, Judy; Chua, Sarah; Vaturi, Mordehay; Ton-Nu, Thanh-Thao; Handschumacher, Mark D.; Levine, Robert A.

doi:10.1016/j.amjcard.2009.05.043

Cited by 111 publications

(55 citation statements)

References 28 publications

(29 reference statements)

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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%

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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%

“…The vena contracta area (VCA) was manually traced using the magnified view mode. 19,20 This measure is independent of geometric assumptions regarding the MR flow field and robust relative to color Doppler setting that varies the size of the turbulent atrial jet.…”

Section: Otani Et Al Secondary Tethering In Primary MV Prolapse S215mentioning

confidence: 99%

Evidence of a Vicious Cycle in Mitral Regurgitation With Prolapse

et al. 2012

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“…7,11,12 After adjusting a cut plane orthogonal to the regurgitant jet at level of mitral valve commissural line, direct planimetry of VCA could be done before the procedure. The regurgitant volume (RV) was calculated by multiplying VCA and velocity time integral obtained by continuous-wave Doppler.…”

Section: Three Dimensional Tee To Assess Mitral Valve Morphology and mentioning

confidence: 99%

Analysis of Procedural Effects of Percutaneous Edge-to-Edge Mitral Valve Repair by 2D and 3D Echocardiography

Altiok

Hamada

Brehmer

et al. 2012

Circ: Cardiovascular Imaging

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Background-Analysis of procedural effects in patients undergoing percutaneous mitral valve repair (PMVR) using the edgeto-edge technique is complex, and common methods to define mitral regurgitation severity based on 2-dimensional (2D) echocardiography are not validated for postprocedural double-orifice mitral valve. This study used 3D transesophageal echocardiography (TEE) to determine the functional and morphological effects of PMVR. Methods and Results-In 39 high-risk surgical patients with moderate to severe functional mitral valve regurgitation, 3D TEE with and without color Doppler as well as 2D transthoracic and TEE was performed before and after PMVR (MitraClip device). Mitral valve regurgitant volume by color Doppler 3D TEE was determined as the product of vena contracta areas defined by direct planimetry and velocity time integral using continuous-wave Doppler. Regurgitant volume was reduced from 84.1±38.3 mL preintervention to 35.6±25.6 mL postintervention. Patients in whom vena contracta area could be reduced >50% had a smaller preprocedural mitral annulus area compared with patients with ≤50% reduction (11.9±3.9 versus 16.1±8.5 cm 2 , respectively; P=0.036) and tended to have a smaller mitral annulus circumference (13.0±2.0 versus 14.8±4.1 cm, respectively; P=0.112). At 6 months follow-up, left atrial and left ventricular end-diastolic volumes were significantly more reduced in patients in whom regurgitant vena contracta area was reduced by >50% compared with those with less reduction (−11.4±5.2 versus −4.8±7.7%; P=0.005, and −11.0±7.2 versus −4.5±9.3%; P=0.028). The maximum diastolic mitral valve area decreased from 6.0±2.0 to 2.9±0.9 cm 2 (P<0.0001). Conclusions-Three

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“…This good correlation between the VC and MR has also been described in humans (Hall et al, 1997). In studies of three-dimensional echocardiography in humans, VC was also a representative index of the severity of MR (Little et al, 2008;Yosefy et al, 2009). In our study there were differences between the studied groups, with group III (with CHF) presenting the highest values for the VC.…”

Section: Discussionmentioning

confidence: 77%