Clinical application of transthoracic volume-rendered three-dimensional echocardiography in the assessment of mitral regurgitation.
Two-dimensional echocardiography (2-DE) and Doppler methods are generally used for assessing mechanisms and severity of mitral regurgitation (MR). Recently, 3-dimensional echocardiography (3-DE) has been applied successfully in various cardiac disorders, but its value in evaluating the mechanism and the severity of MR are not known. We studied 30 patients with MR using 2-DE and 3-DE. Volume-rendered gray-scale 3-DE images of the mitral valve apparatus and MR jets were reconstructed. Maximal volume of the MR jet by 3-DE was compared with mitral regurgitant volume and fraction, regurgitant jet area and the ratio of jet area to left atrial area, and semiquantitative grading derived from 2-DE methods. Our results demonstrated that 3-DE aided in a better depiction of the mitral apparatus and its abnormalities in 70% of the patients. The origin, direction, and morphology of the MR jet were better delineated in 3-DE volumetric display. Quantitative analysis, however, showed only a weak to moderate correlation between 3-DE maximal MR jet volume and 2-DE mitral regurgitant volume (y = 0.5x + 11.4, r = 0.7), regurgitant fraction (y = 0.5x + 8.2, r = 0.65), mitral regurgitant jet area (y = 0.2x + 5, r = 0.51), jet area to left atrial area ratio (y = 0.53x + 7.6, r = 0.54), and semiquantitative grading of MR (y = 9.1x - 1.8, r = 0.74). In conclusion, 3-DE aids in a better understanding of the mechanisms of MR and morphology of the regurgitant jets. Its quantitative ability, when reconstruction of the jet alone is used, may be limited.
Cardiovascular Imaging and Hemodynamic Laboratory, New England Medical Center, Tufts University School of Medicine, Boston, Massachusetts 02111, USA.
J
J
Yao
N D
ND
Masani
Q L
QL
Cao
P
P
Nikuta
N G
NG
Pandian
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015986:Confounding Factors, Epidemiologic; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging*