title: Live/real time three-dimensional transthoracic echocardiographic assessment of pulmonary regurgitation.
abstract: There is no gold standard for the measurement of pulmonary regurgitation (PR) severity. Two-dimensional (2D) transthoracic echocardiography is most commonly used to quantify PR severity using color Doppler criteria for aortic regurgitation. However, this method is limited by visualization of only one or two dimensions of the proximal PR jet or vena contracta (VC) precluding accurate assessment of its shape or size. This limitation would be expected to be obviated by three-dimensional (3D) transthoracic echocardiography, which could provide a more accurate quantitative assessment of PR severity. This study evaluated 82 adult patients with PR using 2D and 3D. PR VC area by 3D was obtained by planimetry by positioning the cropping plane exactly parallel to the VC, which was viewed en face by cropping of the 3D data set. Regurgitant volumes were calculated by 2D (assuming a circular VC) and by 3D as a product of the VC and velocity time integral obtained by color Doppler-guided conventional Doppler interrogation of the PR jet.The 3D VC area correlated with 2D jet width (JW)/right ventricular outflow tract (RVOT) width (r = 0.71) and 2D VC area (r = 0.79). 3D JW/RVOT width correlated with 2D JW/RVOT (r = 0.87). 3D regurgitant volumes also correlated with 2D regurgitant volumes (r = 0.76). The 3D VC values of <0.20, 0.20-0.45, 0.46-1.15, and >1.15 cm(2) and regurgitant volumes of <15 ml, 15-50 ml, 51-115 ml, and >115 ml were effective as cutoffs for grades 1, 2, 3, and 4 PR, respectively. In conclusion, quantification of 3D VC area and regurgitant volumes correlate reasonably well with the current 2D methods for measurement of PR. Since 3D visualizes PR VC in three dimensions, it would be expected to provide a more accurate and more quantitative assessment of PR severity as compared to 2D.
authors.affiliation: Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama 35249, USA.
authors.forename: Koteswara R
authors.initials: KR
authors.lastname: Pothineni
authors.forename: Bryan J
authors.initials: BJ
authors.lastname: Wells
authors.forename: Ming Chon
authors.initials: MC
authors.lastname: Hsiung
authors.forename: Navin C
authors.initials: NC
authors.lastname: Nanda
authors.forename: Pridhvi
authors.initials: P
authors.lastname: Yelamanchili
authors.forename: Thouantosaporn
authors.initials: T
authors.lastname: Suwanjutah
authors.forename: A N Ravi
authors.initials: AN
authors.lastname: Prasad
authors.forename: Sachin
authors.initials: S
authors.lastname: Hansalia
authors.forename: Chang-Chyi
authors.initials: CC
authors.lastname: Lin
authors.forename: Wei-Hsian
authors.initials: WH
authors.lastname: Yin
authors.forename: Mason-Shing
authors.initials: MS
authors.lastname: Young
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003199:Computer Systems; D004452:Echocardiography / Q000379:methods*; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011665:Pulmonary Valve Insufficiency / Q000000981:diagnostic imaging*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity