title: Real-time 3D transoesophageal measurement of the mitral valve area in patients with mitral stenosis.
abstract: OBJECTIVE
  Planimetry measured by two-dimensional transthoracic echocardiography (TTE, MVA2D) is the reference method for the evaluation of the severity of mitral stenosis (MS) but requires experienced operators and good echocardiographic windows. Real-time three-dimensional transoesophageal echocardiography (3D-TEE, MVA3D) may overcome these limitations but its accuracy has never been evaluated.
  
  
  RESULTS
  We prospectively enrolled 80 patients (58±15 years, 86% female) referred for MS evaluation who underwent, within 1 week, a clinically indicated TTE and TEE. MVA2D was measured by experienced operators (Level III), MVA3D by one experienced and one non-experienced (Level I) operators blinded of any clinical or TTE information. MVA3D measured by the experienced operator [1.11±0.32 cm2; median, 1.1 cm2; range (0.45-2.20)] did not differ from and correlated well with MVA2D [1.10±0.34 cm2; median, 1.05 cm2; range (0.45-2.30)], P=0.87; r=0.79, P<0.0001; ICC=0.79) and mean difference between methods was small (+0.004±0.21 cm2). MVA3D measured by the non-experienced operator [1.08±0.34 cm2; median 1.02 cm2; range (0.45-2.23)] also did not differ from and correlated well with MVA2D measured by experienced operators (P=0.25; r=0.86, P<0.0001; mean difference -0.02±0.18 cm2; ICC=0.86). Intra and interobserver variability were 0.02±0.25 and 0.01±0.33 cm2.
  
  
  CONCLUSIONS
  3D-TEE provides accurate and reproducible MVA measurements similar to 2D planimetry performed by experienced operators. Thus, 3D-TEE could be considered as a second-line alternative tool for the evaluation of MS severity in patients with poor echocardiographic windows or for team less accustomed to evaluate MS patients.
authors.affiliation: Department of Cardiology, Bichat Hospital, and INSERM, U698, University Paris 7, 46 rue Henri Huchard, 75018 Paris, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Dreyfus
authors.forename: Eric
authors.initials: E
authors.lastname: Brochet
authors.forename: Laurent
authors.initials: L
authors.lastname: Lepage
authors.forename: David
authors.initials: D
authors.lastname: Attias
authors.forename: Caroline
authors.initials: C
authors.lastname: Cueff
authors.forename: Delphine
authors.initials: D
authors.lastname: Detaint
authors.forename: Dominique
authors.initials: D
authors.lastname: Himbert
authors.forename: Bernard
authors.initials: B
authors.lastname: Iung
authors.forename: Alec
authors.initials: A
authors.lastname: Vahanian
authors.forename: David
authors.initials: D
authors.lastname: Messika-Zeitoun
mesh_terms: D000328:Adult; D000368:Aged; D004452:Echocardiography; D019560:Echocardiography, Three-Dimensional; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging*; D008946:Mitral Valve Stenosis / Q000000981:diagnostic imaging*; D011446:Prospective Studies; D015203:Reproducibility of Results