title: Characterization of degenerative mitral valve disease using morphologic analysis of real-time three-dimensional echocardiographic images: objective insight into complexity and planning of mitral valve repair.
abstract: BACKGROUND
  Presurgical planning of mitral valve (MV) repair in patients with Barlow disease (BD) and fibroelastic deficiency (FED) is challenging because of the inability to assess accurately the complexity of MV prolapse. We hypothesized that the etiology of degenerative MV disease (DMVD) could be objectively and accurately ascertained using parameters of MV geometry obtained by morphological analysis of real-time 3D echocardiographic (RT3DE) images.
  
  
  RESULTS
  Seventy-seven patients underwent transesophageal RT3DE study: 57 patients with DMVD studied intraoperatively (28 BD, 29 FED classified during surgery) and 20 patients with normal MV who were used as control subjects (NL). MVQ software (Philips) was used to measure parameters of annular dimensions and geometry and leaflet surface area, including billowing volume and height. The Student t test and multinomial logistic regression was performed to identify parameters best differentiating DMVD patients from normal as well as FED from BD. Morphological analysis in the DMVD group revealed a progressive increase in multiple parameters from NL to FED to BD, allowing for accurate diagnosis of these entities. The strongest predictors of the presence of DMVD included billowing height and volume. Three-dimensional billowing height with a cutoff value of 1.0 mm differentiated DMVD from NL without overlap, and billowing volume with a cutoff value 1.15 mL differentiated between FED and BD without overlap.
  
  
  CONCLUSIONS
  Morphological analysis as a form of decision support in assessing MV billowing revealed significant quantifiable differences between NL, FED, and BD patients, allowing accurate classification of the etiology of MV prolapse and determination of the anticipated complexity of repair.
authors.affiliation: University of Chicago Medical Center, Chicago, IL, USA.
authors.forename: Sonal
authors.initials: S
authors.lastname: Chandra
authors.forename: Ivan S
authors.initials: IS
authors.lastname: Salgo
authors.forename: Lissa
authors.initials: L
authors.lastname: Sugeng
authors.forename: Lynn
authors.initials: L
authors.lastname: Weinert
authors.forename: Wendy
authors.initials: W
authors.lastname: Tsang
authors.forename: Masaaki
authors.initials: M
authors.lastname: Takeuchi
authors.forename: Kirk T
authors.initials: KT
authors.lastname: Spencer
authors.forename: Anne
authors.initials: A
authors.lastname: O'Connor
authors.forename: Michael
authors.initials: M
authors.lastname: Cardinale
authors.forename: Scott
authors.initials: S
authors.lastname: Settlemier
authors.forename: Victor
authors.initials: V
authors.lastname: Mor-Avi
authors.forename: Roberto M
authors.initials: RM
authors.lastname: Lang
mesh_terms: D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D017548:Echocardiography, Transesophageal / Q000379:methods*; D005260:Female; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging* / Q000601:surgery*; D015588:Observer Variation; D011300:Preoperative Care / Q000379:methods*; D011446:Prospective Studies; D012372:ROC Curve; D015203:Reproducibility of Results