Non-invasive assessment of mitral valve area during percutaneous balloon mitral valvuloplasty: role of real-time 3D echocardiography.
BACKGROUND
In the last decade, multiple studies depicted discrepancies between mitral valvular orifice area (MVA) measurements obtained with the pressure half-time (PHT) method and invasive methods during the immediate post-percutaneous mitral valvuloplasty (PMV) period. Our aim was to assess the accuracy of Real-Time 3D echo (RT3D) to measure the MVA in the immediate post-PMV period. The invasively determined MVA was used as the gold standard.


RESULTS
We studied 29 patients with rheumatic mitral stenosis from two centres (27 women; mean age 48.2+/-11.3 years), all of which had underwent PMV. MVA was calculated before and after PMV using the PHT method, 2D echo planimetry, RT3D echo planimetry and invasive determination (Gorlin's method). The RT3D MVA assessment showed a better agreement with the invasively derived MVA before and in the immediate post-PMV period (Bland-Altman analysis: Average difference between both methods and limits of agreement: 0.01 (-0.31 to 0.33) cm(2) and -0.12 (-0.71 to 0.47) cm(2)) before and immediately after the PMV, respectively.


CONCLUSIONS
RT3D is a feasible and accurate technique for measuring MVA in patients with RMVS. It has the best agreement with the invasively determined MVA, particularly in the immediate post-PMV period.
Zamorano
José
J
Echocardiography Laboratory of the Hospital Clínico de San Carlos, Instituto Cardiovascular, 28040 Madrid, Spain. jlzamorano@vodafone.es
Perez de Isla
Leopoldo
L
Sugeng
Lissa
L
Cordeiro
Pedro
P
Rodrigo
José Luis
JL
Almeria
Carlos
C
Weinert
Lynn
L
Feldman
Ted
T
Macaya
Carlos
C
Lang
Roberto M
RM
Hernandez Antolin
Rosana
R
D000328:Adult; D002404:Catheterization / Q000379:methods*; D019560:Echocardiography, Three-Dimensional / Q000379:methods* / Q000592:standards; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008946:Mitral Valve Stenosis / Q000000981:diagnostic imaging* / Q000628:therapy; D015588:Observer Variation; D012214:Rheumatic Heart Disease / Q000000981:diagnostic imaging / Q000628:therapy; D018084:Ultrasonography, Interventional