title: A methodology for assessing human mitral leaflet curvature using real-time 3-dimensional echocardiography.
abstract: OBJECTIVE
  Using 3-dimensional echocardiography in conjunction with novel geometric modeling and rendering techniques, we have developed a high-resolution, quantitative, 3-dimensional methodology for imaging the human mitral valve. Leaflet and annular geometry are important determinants of mitral valve stress. Repair techniques that optimize valvular geometry will reduce stress and potentially increase repair durability. The development of such procedures will require image-processing methodologies that provide a quantitative description of 3-dimensional valvular geometry.
  
  
  METHODS
  Ten healthy adult subjects underwent mitral valve imaging with real-time 3-dimensional echocardiography. By using specially designed image analysis software, multiple valvular geometric parameters, including 2- and 3-dimensional leaflet curvature, leaflet surface area, annular height, intercommissural width, septolateral annular diameter, and annular area were determined for each subject. Image-rendering techniques that allow for the clear and concise presentation of this detailed information are also presented.
  
  
  RESULTS
  Although 3-dimensional annular and leaflet geometry were found to be highly conserved between healthy human subjects in general, substantial intrasubject and intersubject regional geometric heterogeneity was observed in the midposterior leaflet, the region most commonly involved in leaflet flail in subjects with myxomatous disease.
  
  
  CONCLUSIONS
  The image-processing and graphic-rendering techniques that we have developed can be used to provide a complete description of 3-dimensional mitral valve geometry in human subjects. Widespread application of these techniques to healthy subjects and patients with mitral valve disease will provide insight into the geometric basis of both valvular pathology and repair durability.
authors.affiliation: Harrison Department of Surgical Research, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
authors.forename: Liam P
authors.initials: LP
authors.lastname: Ryan
authors.forename: Benjamin M
authors.initials: BM
authors.lastname: Jackson
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Eperjesi
authors.forename: Theodore J
authors.initials: TJ
authors.lastname: Plappert
authors.forename: Martin
authors.initials: M
authors.lastname: St John-Sutton
authors.forename: Robert C
authors.initials: RC
authors.lastname: Gorman
authors.forename: Joseph H
authors.initials: JH
authors.lastname: Gorman
mesh_terms: D000328:Adult; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007206:Individuality; D008297:Male; D008943:Mitral Valve / Q000033:anatomy & histology / Q000000981:diagnostic imaging*; D016011:Normal Distribution