Live/Real Time Three‐Dimensional Transthoracic Echocardiographic Assessment of Pulmonary Regurgitation

Abstract

There is no gold standard for the measurement of pulmonary regurgitation (PR) severity. Two-dimensional (2D) transthoracic echocardiography is most commonly used to quantify PR severity using color Doppler criteria for aortic regurgitation. However, this method is limited by visualization of only one or two dimensions of the proximal PR jet or vena contracta (VC) precluding accurate assessment of its shape or size. This limitation would be expected to be obviated by three-dimensional (3D) transthoracic echocardiography, which could provide a more accurate quantitative assessment of PR severity. This study evaluated 82 adult patients with PR using 2D and 3D. PR VC area by 3D was obtained by planimetry by positioning the cropping plane exactly parallel to the VC, which was viewed en face by cropping of the 3D data set. Regurgitant volumes were calculated by 2D (assuming a circular VC) and by 3D as a product of the VC and velocity time integral obtained by color Doppler-guided conventional Doppler interrogation of the PR jet.The 3D VC area correlated with 2D jet width (JW)/right ventricular outflow tract (RVOT) width (r = 0.71) and 2D VC area (r = 0.79). 3D JW/RVOT width correlated with 2D JW/RVOT (r = 0.87). 3D regurgitant volumes also correlated with 2D regurgitant volumes (r = 0.76). The 3D VC values of <0.20, 0.20-0.45, 0.46-1.15, and >1.15 cm(2) and regurgitant volumes of <15 ml, 15-50 ml, 51-115 ml, and >115 ml were effective as cutoffs for grades 1, 2, 3, and 4 PR, respectively. In conclusion, quantification of 3D VC area and regurgitant volumes correlate reasonably well with the current 2D methods for measurement of PR. Since 3D visualizes PR VC in three dimensions, it would be expected to provide a more accurate and more quantitative assessment of PR severity as compared to 2D.

Three-Dimensional Echocardiography in Adult Congenital Heart Disease

“…The use of RT3DE in assessment of valvular regurgitation by proximal isovelocity surface area analysis theoretically should be more accurate given that the vena contracta is visualized in all three dimensions. Pothineni et al [22] found that quantification of pulmonary regurgitation with 3D correlated well to the accepted methods of quantifying pulmonary regurgitation with 2DE.…”

Peri‐operative assessment of right heart function: role of echocardiography

“…The other advantages of 3D echocardiography for imaging of the right heart-related pathology also encompass applications in advanced heart failure, congenital heart disease such as atrial septal defects, pulmonary embolism, pulmonary hypertension, RV dysplasia and valvular disorders including the calculation of regurgitant volumes [52][53][54][55]. Furthermore, the assessment and diagnosis of right-sided valvular vegetations, abscesses and perforations are significantly improved by 3D compared to 2D imaging and in the case of cardiac tumours, 3D echocardiography can provide spatial information regarding size, shape, surface morphology of the right-sided cardiac tumours including attachment sites, movement of any satellites, valvular involvement and the competency of the surrounding structures to facilitate surgical planning [41].…”

Evolving Role of Three-Dimensional Echocardiography in the Cardiac Surgical Patient

“…3D TEE can be helpful by identifying the location pathology, mechanism of PV dysfunction, and accurate RV outflow tract measurements in patients with congenital RV outflow tract obstruction. Furthermore, 3D TTE improved the accuracy in the assessment of pulmonary regurgitation, leadingto improved timing of surgical intervention [57]. 3D TEE revealed that right ventricular outflow (RVOT) geometry was not generally circular but oval with two different types: horizontal and vertical RVOT shapes.…”