Which method should be the reference method to evaluate the severity of rheumatic mitral stenosis? Gorlin's method versus 3D-echo

Isla, Leopoldo Pérez de; Casanova, Carlos A.; Almerı́a, Carlos; Rodrigo, José Luis; Cordeiro, Pedro; Mataix, Luis; Aubele, Adalía; Lang, Roberto M.; Zamorano, José Luís

doi:10.1016/j.euje.2006.08.008

Cited by 57 publications

(33 citation statements)

References 8 publications

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“…As well, multiplanar reformations from 3DE images can consistently identify the smallest stenotic orifice for area measurements, and these 3DE area measurements are known to correlate strongly with area measurements derived invasively using the Gorlin formula. 7,96 In contrast, 2D planimetry often overestimates the orifice area when patient image quality is poor or if the narrowest cross-sectional orifice is not properly identified. In cases of rheumatic mitral stenosis, a 3D echocardiographybased score for percutaneous balloon mitral valvuloplasty has been developed with improved predictive value of success compared with the 2D echocardiography-based Wilkins score.…”

Section: Guidelines and Standardsmentioning

confidence: 99%

EAE/ASE Recommendations for Image Acquisition and Display Using Three-Dimensional Echocardiography

Lang

Badano

Tsang

et al. 2012

Journal of the American Society of Echocardiography

864

513

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Section: Guidelines and Standardsmentioning

confidence: 99%

EAE/ASE Recommendations for Image Acquisition and Display Using Three-Dimensional Echocardiography

Lang

Badano

Tsang

et al. 2012

Journal of the American Society of Echocardiography

864

513

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“…5 Three-dimensional transesophageal echocardiography (3D TEE) has the potential to be the method of choice for MVA assessment. [6][7][8] Historically, however, invasive measurements were used for the validation of the PHT method for assessment of MVA in stenotic native valves. 9 The aim of this study was to compare different 2D and 3D echocardiographic methods of MVA assessment and invasive MVA calculations and to define which of these measurements best predicts an elevated transmitral gradient at discharge.…”

Section: Clinical Perspective On P 1040mentioning

confidence: 99%

Assessment of Mitral Valve Area During Percutaneous Mitral Valve Repair Using the MitraClip System

Biaggi

Felix

Gruner

et al. 2013

Circ: Cardiovascular Imaging

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Background-Quantification of the mitral valve area (MVA) is important to guide percutaneous mitral valve repair using the MitraClip system. However, little is known about how to best assess MVA in this specific situation. Methods and Results-Immediately before and after MitraClip implantation, transesophageal echocardiography data were acquired for MVA assessment by the pressure half-time method and by two 3D quantification methods (mitral valve quantification software and 3D quantification software). In addition, transmitral gradients by continuous-wave Doppler (dPmean CW ) were measured to indirectly assess MVA. Data are given as median (interquartile range). Thirty-three patients (39% women) with a median age of 77.1 years (12.4 years) were studied. Before intervention, the median MVAs by the pressure half-time method, mitral valve quantification software, and 3D quantification software were 4.4 cm 2 (2.0 cm 2 ), 4.7 cm 2 (2.4 cm 2 ), and 6.2 cm 2 (2.4 cm 2 ), respectively (P<0.001). After intervention, MVA was reduced to 1.9 cm 2 (0.7 cm 2 ), 2.1 cm 2 (1.1 cm 2 ), and 2.8 cm 2 (1.1 cm 2 ), respectively (P=0.001). The median values for dPmean CW before and after intervention were 1.0 mm Hg (1.0 mm Hg) and 3.0 mm Hg (3.0 mm Hg; P<0.001), respectively. At discharge, the median dPmean CW was 4.0 mm Hg (3.0 mm Hg). In multivariate regression analyses including body surface area, the 3 different MVA methods, and dPmean CW , a post-dPmean CW ≥5 mm Hg was the best independent predictor of an elevated transmitral gradient at discharge. Methods Patient PopulationWe included consecutive patients undergoing percutaneous MVR using the MitraClip system at the University Hospital Zurich, Zurich, Switzerland. Patients were selected for the procedure according to both the current guidelines on valvular heart disease and the previously published guidelines. 1,10,11 The clinical patient data were obtained by chart review. All patients gave written informed consent for inclusion in a prospective MitraClip registry (MitraSwiss registry). The protocol of the MitraSwiss registry was approved by the local institutional review board. EchocardiographyTEE was performed using a Philips iE33 platform and an X7-2t real-time 3D TEE probe (Philips Medical Systems, Andover, MA). A 2D TTE was performed in all patients at the time of discharge. All measurements were performed according to the guidelines.12 MR was graded mild (1+), moderate (2+), moderate to severe (3+), and severe (4+).11 Mitral stenosis was defined by an MVA <2 cm 2 : mild, by 1.5 to 1.99 cm 2 ; moderate, by 1.0 to 1.49 cm 2 ; and severe, by <1 cm 2 . In addition, a mean transvalvular gradient ≥5 mm Hg was considered stenosed mitral valve. 4,13 Immediately before the start of the procedure and after the last clip was placed, continuous-wave (CW) Doppler of mitral valve inflow was used for the assessment of the mean gradient across the mitral valve (dPmean CW ) and of MVA by PHT (MVA PHT ). 9 The beam of the CW Doppler was located in the center of the largest orifice after ...

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“…Three-dimensional imaging of the mitral regurgitant jet may allow more accurate quantification of regurgitation severity (105). RT3DE planimetry of the mitral valve area also may be superior to invasive methods for assessing the severity of mitral stenosis (105,106).…”

Section: Real-time 3-dimensional Echocardiographymentioning

confidence: 99%

Imaging studies in patients with heart failure: Current and evolving technologies

Glassberg

Kirkpatrick²,

Ferrari³

2008

Critical Care Medicine

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Technological advances continue to expand the clinical role of echocardiography in the intensive care unit, particularly in patients with heart failure. It has many advantages over tomographic techniques such as echo cardiac magnetic resonance imaging and cardiac computed tomography, can provide rapid bedside cardiac assessment, and facilitate emergent decision-making for critically ill patients. Image quality problems in the intensive care setting have largely been overcome by the use of harmonic imaging, contrast opacification, and when indicated, transesophageal echocardiography. Newer techniques promise to advance the scope and prognostic power of echocardiography, and to expand the portability and availability of this tool.

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Which method should be the reference method to evaluate the severity of rheumatic mitral stenosis? Gorlin's method versus 3D-echo

Abstract: We should keep in mind the fact that 3D-echo planimetry may be a better reference method than the Gorlin method to assess the severity of rheumatic mitral stenosis.

Cited by 57 publications

References 8 publications

EAE/ASE Recommendations for Image Acquisition and Display Using Three-Dimensional Echocardiography

EAE/ASE Recommendations for Image Acquisition and Display Using Three-Dimensional Echocardiography

Assessment of Mitral Valve Area During Percutaneous Mitral Valve Repair Using the MitraClip System

Imaging studies in patients with heart failure: Current and evolving technologies

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