New quantitative three-dimensional echocardiographic indices of mitral valve stenosis: new 3D indices of mitral stenosis.
BACKGROUND
We studied the value of quantitative three-dimensional echocardiography (3DE) in the evaluation of mitral valve stenosis using the measurement of the mitral valve area (MVA) with two new indices: the doming volume and mitral valve volume.


RESULTS
A total of 45 consecutive patients with mitral valve stenosis were studied. MVA was measured using Doppler with the pressure half-time (PHT) method. Following a diagnostic multiplane transesophageal (TEE) examination, data for 3DE were acquired with a rotational mode of acquisition. MVA was assessed by anyplane echocardiography (APE) and from surface rendered images. Moreover, the doming volume, i.e., the volume subtended by the anterior and posterior mitral valve and annular cut plane was measured by APE. Comparing PHT-derived with 3DE-derived MVA's, using both APE and surface rendered images, only moderate correlations were observed: PHT-derived MVA versus APE-derived MVA: r = 0.74, P < 0.0001; PHT-derived area versus 3DE-surface rendered MVA: r = 0.70, P < 0.0001. Multiple linear regression analysis showed a relation of atrial fibrillation to the doming volume (P = 0.04), but not to PHT-derived MVA (P = 0.28), APE-derived area (P = 0.33) and mitral valve volume (P = 0.08). Comparison of patients with MVA < 1 cm(2) and MVA > 1 cm(2) revealed significant difference in mitral valve volume: mean mitral valve volume in critical stenosis was 3.7 ml versus 1.4 ml in non-critical stenosis (P = 0.04).


CONCLUSIONS
Only moderate correlations between 3DE and Doppler-derived MVA's were observed. Measurement of the doming volume allows quantification of the 3DE geometry of the mitral apparatus. Patients with conical or funnel-like geometry are more likely to have sinus rhythm, whereas, patients with flat geometry are likely to have atrial fibrillation. Mitral valve volume can be used for the evaluation of mitral stenosis severity. These new 3DE indices might be used for selection of patients for balloon valvuloplasty.
Valocik
Gabriel
G
3rd Department of Internal Medicine, Safarik University Hospital, Rastislavova 43, 040 11, Kosice, Slovakia. valocik@central.medic.upjs.sk
Kamp
Otto
O
Mannaerts
Herman F J
HF
Visser
Cees A
CA
D000293:Adolescent; D000328:Adult; D000368:Aged; D019560:Echocardiography, Three-Dimensional; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D008946:Mitral Valve Stenosis / Q000000981:diagnostic imaging*; D012720:Severity of Illness Index