Spatiotemporal Complexity of Vena Contracta and Mitral Regurgitation Grading Using Three-Dimensional Echocardiographic Analysis

Lozano-Edo, Silvia; Jover-Pastor, Pablo; Osa-Sáez, Ana; Buendía-Fuentes, Francisco; Rodríguez‐Serrano, María; Arnau-Vives, Miguel Ángel; Rueda-Soriano, Joaquín; Calvillo-Batlles, Pilar; Fonfria-Esparcia, Carles; Martínez‐Dolz, Luis; Agüero, Jaume

doi:10.1016/j.echo.2022.09.021

Cited by 4 publications

(4 citation statements)

References 49 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The mitral valve apparatus is a complex structure and its morphology and shape vary through the cardiac cycle; thus, the regurgitation orifice can also show dynamic changes, especially in functional MR. Lozano-Edo et al [18] have outlined that 3D VCA has a spatialtemporal modification over the cardiac systole that can challenge the assumption of a circular and fixed regurgitation orifice.…”

mentioning

confidence: 99%

Contemporary Echocardiographic Evaluation of Mitral Regurgitation and Guidance for Percutaneous Mitral Valve Repair

Marchetti,

Di Lenarda,

Novembre

et al. 2023

JCM

View full text Add to dashboard Cite

Mitral valve regurgitation (MR) is a multifaceted valvular heart disease. Echocardiography plays a central role in etiology assessment, severity quantification, treatment candidacy, outcome evaluation, and patient follow-up. In this review, we describe the comprehensive echocardiographic assessment of MR, including transthoracic (TTE) and transesophageal (TEE) approaches, 2D and 3D modalities, strain imaging, stress echocardiography, and artificial intelligence (AI) applications. Transcatheter edge-to-edge mitral valve repair (TEER) has been established as a key therapy for patients with severe, symptomatic MR and high surgical risk. TEER is performed under TEE guidance. We outline a practical overview of echocardiographic guidance on TEER.

show abstract

mentioning

confidence: 99%

Contemporary Echocardiographic Evaluation of Mitral Regurgitation and Guidance for Percutaneous Mitral Valve Repair

Marchetti,

Di Lenarda,

Novembre

et al. 2023

JCM

View full text Add to dashboard Cite

show abstract

“…Also the assumed independency of 2D-VCW from LV-LA driving pressure or regurgitant flow rate for a fixed orifice is questionable (88). Noteworthy the 2D-VCW does not consider the dynamic variations of MR throughout systole because it is measured in a single frame (89). Despite these important limitations, measuring 2D-VCW sometimes helps in grading MR, notably when the PISA method is not reliable because of a wallconstrained flow field.…”

Section: D-vena Contracta Widthmentioning

confidence: 99%

Quantification of primary mitral regurgitation by echocardiography: A practical appraisal

Altes

Vermès²,

Lévy³

et al. 2023

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

The accurate quantification of primary mitral regurgitation (MR) and its consequences on cardiac remodeling is of paramount importance to determine the best timing for surgery in these patients. The recommended echocardiographic grading of primary MR severity relies on an integrated multiparametric approach. It is expected that the large number of echocardiographic parameters collected would offer the possibility to check the measured values regarding their congruence in order to conclude reliably on MR severity. However, the use of multiple parameters to grade MR can result in potential discrepancies between one or more of them. Importantly, many factors beyond MR severity impact the values obtained for these parameters including technical settings, anatomic and hemodynamic considerations, patient's characteristics and echocardiographer' skills. Hence, clinicians involved in valvular diseases should be well aware of the respective strengths and pitfalls of each of MR grading methods by echocardiography. Recent literature highlighted the need for a reappraisal of the severity of primary MR from a hemodynamic perspective. The estimation of MR regurgitation fraction by indirect quantitative methods, whenever possible, should be central when grading the severity of these patients. The assessment of the MR effective regurgitant orifice area by the proximal flow convergence method should be used in a semi-quantitative manner. Furthermore, it is crucial to acknowledge specific clinical situations in MR at risk of misevaluation when grading severity such as late-systolic MR, bi-leaflet prolapse with multiple jets or extensive leak, wall-constrained eccentric jet or in older patients with complex MR mechanism. Finally, it is debatable whether the 4-grades classification of MR severity would be still relevant nowadays, since the indication for mitral valve (MV) surgery is discussed in clinical practice for patients with 3+ and 4+ primary MR based on symptoms, specific markers of adverse outcome and MV repair probability. Primary MR grading should be seen as a continuum integrating both quantification of MR and its consequences, even for patients with presumed “moderate” MR.

show abstract

“…However, it has a significant limitation, since the great majority of patients who have sMR have a noncircular vena contracta. 41 One way to overcome this limitation is to perform a biplane measurement (average between apical twoand four-chamber views), with a threshold of >8 mm for severe insufficiency. 39 With the advent of 3D echocardiography, 3D vena contracta area of >0.4 cm 2 has also been proposed as a robust parameter to identify severe MR. 42,43 Several complementary measures are recommended, including the pattern of origin and distribution of the MR jet, the evaluation of pulmonary vein systolic flow, and the evaluation of mitral inflow pattern and E wave peak velocity.…”

Section: Evaluation Of the Mitral Valve Apparatus In Cardiomyopathiesmentioning

confidence: 99%

“…However, it has a significant limitation, since the great majority of patients who have sMR have a non-circular vena contracta. 41 One way to overcome this limitation is to perform a biplane measurement (average between apical two- and four-chamber views), with a threshold of >8 mm for severe insufficiency. 39 With the advent of 3D echocardiography, 3D vena contracta area of >0.4 cm 2 has also been proposed as a robust parameter to identify severe MR. 42 , 43 …”

Section: Evaluation Of the Mitral Valve Apparatus In Cardiomyopathiesmentioning

confidence: 99%

Parameters of the mitral apparatus in patients with ischemic and nonischemic dilated cardiomyopathy

Presume,

Paiva,

Guerreiro

et al. 2023

J Int Med Res

View full text Add to dashboard Cite

The mitral valve apparatus is a complex structure consisting of several coordinating components: the annulus, two leaflets, the chordae tendineae, and the papillary muscles. Due to the intricate interplay between the mitral valve and the left ventricle, a disease of the latter may influence the normal function of the former. As a consequence, valve insufficiency may arise despite the absence of organic valve disease. This is designated as functional or secondary mitral regurgitation, and it arises from a series of distortions to the valve components. This narrative review describes the normal anatomy and the pathophysiology behind the mitral valve changes in ischemic and non-ischemic dilated cardiomyopathies. It also explains the value of a complete multiparametric assessment of this structure. Not only must an assessment include quantitative measures of regurgitation, but also various anatomical parameters from the mitral apparatus and left ventricle, since they carry prognostic value and are predictors of mitral valve repair success and durability.

show abstract

Spatiotemporal Complexity of Vena Contracta and Mitral Regurgitation Grading Using Three-Dimensional Echocardiographic Analysis

Cited by 4 publications

References 49 publications

Contemporary Echocardiographic Evaluation of Mitral Regurgitation and Guidance for Percutaneous Mitral Valve Repair

Contemporary Echocardiographic Evaluation of Mitral Regurgitation and Guidance for Percutaneous Mitral Valve Repair

Quantification of primary mitral regurgitation by echocardiography: A practical appraisal

Parameters of the mitral apparatus in patients with ischemic and nonischemic dilated cardiomyopathy

Contact Info

Product

Resources

About