title: Mitral valve analysis adding a virtual semi-transparent annulus plane for detection of prolapsing segments.
abstract: BACKGROUND
  We hypothesized that a novel three-dimensional virtual semi-transparent annulus plane (3D VSAP) presented on a holographic screen can be used to visualize the prolapsing tissue in degenerative mitral valve disease and furthermore, provide us with geometrical data of the mitral valve apparatus. Phantom and patient studies were designed to demonstrate the feasibility of creating a semi-automatic, semi-transparent mitral annulus plane visualized on a holographic display.
  
  
  METHODS
  Ten pipe cleaners mimicking the mitral annulus with different shapes and three types of annuloplasty rings served as phantoms. We obtained 3D transoesophageal examination of the phantoms in a special designed box filled with water. Recordings were converted to the holographic display and a 3D VSAP was created. The ratio of the major and minor axes as well as the non-planar angles were calculated and compared with direct measures of the phantoms. Forty patients with degenerative mitral valve disease were then analyzed with 3D transthoracic echocardiography (TTE) and a 3D VSAP was created on the holographic display. A total of 240 segments were analyzed by two independent observers, one echo expert (observer I), and the other novice with limited echo experience (observer II). The two observers created the 3D VSAP in each patient before suggesting the valve pathology.
  
  
  RESULTS
  The major/minor axes ratio and non-planar angles by 3D VSAP correlated with direct measurements by r = 0.65, p < 0.02 and r = 0.99, p < 0.0001, respectively. The sensitivity and specificity of the 3D VSAP method in patients was 81 and 97%, respectively (observer I) and for observer II 77 and 96%, respectively. The accuracy and precisions were 93.9 and 89.4%, respectively (observer I), 92.3 and 85.1% (observer II). Mitral valve analysis adding a 3D VSAP was feasible with high accuracy and precision, providing a quick and less subjective method for diagnosing mitral valve prolapse. This novel method may improve preoperative diagnostics and may relieve a better understanding of the pathophysiology of mitral valve disease. Thus, based on the specific findings in each patient, a tailored surgical repair can be planned and hopefully enhance long-term repair patency in the future.
authors.affiliation: Department of Cardiothoracic Surgery, Rikshospitalet, Oslo University Hospital, Post Office Box 4950, Nydalen, 0424, Oslo, Norway. kardum@ous-hf.no.
authors.forename: Karl-Andreas
authors.initials: KA
authors.lastname: Dumont
authors.affiliation: Kalkulo AS, Martin Linges vei 17, 1364, Fornebu, Norway. jornskaa@gmail.com.
authors.forename: Jørn Skaarud
authors.initials: JS
authors.lastname: Karlsen
authors.affiliation: Department of Cardiology, Rikshospitalet, Oslo University Hospital, Post Box 4950, Nydalen, 0424, Oslo, Norway. thomhell@medisin.uio.no.
authors.forename: Thomas
authors.initials: T
authors.lastname: Helle-Valle
authors.affiliation: Department of Cardiothoracic Surgery and Faculty of Medicine in Oslo, Rikshospitalet, Oslo University Hospital, Post Office Box 4950, Nydalen, 0424, Oslo, Norway. arnt.fiane@ous-hf.no.
authors.forename: Arnt Eltvedt
authors.initials: AE
authors.lastname: Fiane
authors.affiliation: Department of Cardiothoracic Surgery, Rikshospitalet, Oslo University Hospital, Post Office Box 4950, Nydalen, 0424, Oslo, Norway. runar.lundblad@gmail.com.
authors.forename: Runar
authors.initials: R
authors.lastname: Lundblad
authors.affiliation: Department of Cardiology and Institute for Surgical Research, Rikshospitalet, Oslo University Hospital, Post Office Box 4950, Nydalen, 0424, Oslo, Norway. stig.urheim@rikshospitalet.no.
authors.forename: Stig
authors.initials: S
authors.lastname: Urheim
mesh_terms: D019560:Echocardiography, Three-Dimensional / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006696:Holography / Q000379:methods; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging*; D008945:Mitral Valve Prolapse / Q000000981:diagnostic imaging*; D019047:Phantoms, Imaging; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014584:User-Computer Interface