title: Modeling the Myxomatous Mitral Valve With Three-Dimensional Echocardiography.
abstract: BACKGROUND
  Degenerative mitral valve disease is associated with variable and complex defects in valve morphology. Three-dimensional echocardiography (3DE) has shown promise in aiding preoperative planning for patients with this disease but to date has not been as transformative as initially predicted. The clinical usefulness of 3DE has been limited by the laborious methods currently required to extract quantitative data from the images.
  
  
  METHODS
  To maximize the utility of 3DE for preoperative valve evaluation, this work describes an automated 3DE image analysis method for generating models of the mitral valve that are well suited for both qualitative and quantitative assessment. The method is unique in that it captures detailed alterations in mitral leaflet and annular morphology and produces image-derived models with locally varying leaflet thickness. The method is evaluated on midsystolic transesophageal 3DE images acquired from 22 subjects with myxomatous degeneration and from 22 subjects with normal mitral valve morphology.
  
  
  RESULTS
  Relative to manual image analysis, the automated method accurately represents both normal and complex leaflet geometries with a mean boundary displacement error on the order of one image voxel. A detailed quantitative analysis of the valves is presented and reveals statistically significant differences between normal and myxomatous valves with respect to numerous aspects of annular and leaflet geometry.
  
  
  CONCLUSIONS
  This work demonstrates a successful methodology for the relatively rapid quantitative description of the complex mitral valve distortions associated with myxomatous degeneration. The methodology has the potential to significantly improve surgical planning for patients with complex mitral valve disease.
authors: Gorman Cardiovascular Research Group, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
authors: Alison M
authors: AM
authors: Pouch
authors: Gorman Cardiovascular Research Group, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
authors: Benjamin M
authors: BM
authors: Jackson
authors: Gorman Cardiovascular Research Group, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
authors: Eric
authors: E
authors: Lai
authors: Gorman Cardiovascular Research Group, University of Pennsylvania, Philadelphia, Pennsylvania.
authors: Manabu
authors: M
authors: Takebe
authors: Department of Computer and Information Sciences, University of Pennsylvania, Philadelphia, Pennsylvania.
authors: Sijie
authors: S
authors: Tian
authors: Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California.
authors: Albert T
authors: AT
authors: Cheung
authors: Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California.
authors: Y Joseph
authors: YJ
authors: Woo
authors: Department of Anesthesia, University of Pennsylvania, Philadelphia, Pennsylvania.
authors: Prakash A
authors: PA
authors: Patel
authors: IBM Research, Almaden, San Jose, California.
authors: Hongzhi
authors: H
authors: Wang
authors: Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania.
authors: Paul A
authors: PA
authors: Yushkevich
authors: Gorman Cardiovascular Research Group, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
authors: Robert C
authors: RC
authors: Gorman
authors: Gorman Cardiovascular Research Group, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: gormanj@uphs.upenn.edu.
authors: Joseph H
authors: JH
authors: Gorman
mesh_terms: D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D006338:Heart Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D008943:Mitral Valve / Q000000981:diagnostic imaging*; D009232:Myxoma / Q000000981:diagnostic imaging* / Q000601:surgery