Article

The Role and Potential of 3D Echocardiography in the Assessment of Mitral Regurgitation

Register or Login to View PDF Permissions
Permissions× For commercial reprint enquiries please contact Springer Healthcare: ReprintsWarehouse@springernature.com.

For permissions and non-commercial reprint enquiries, please visit Copyright.com to start a request.

For author reprints, please email rob.barclay@radcliffe-group.com.

  • Views: 344

  • Likes: 0

  • Citations: 3

Average (ratings)
No ratings
Your rating

Keywords

3D echocardiography, mitral valve regurgitation, mitral valve prolapse, mitral valve repair, heart surgery,

Disclosure:The authors have no conflicts of interest to declare.

Received:

Accepted:

DOI:https://doi.org/10.15420/ecr.2012.8.3.165

Acknowledgements:The authors wish to express their gratitude to Anikó Hegedűs, Department of Anaesthesiology and Intensive Therapy, Semmelweis University Budapest, for her valuable assistance in the completion of the bibliography.

Copyright Statement:

The copyright in this work belongs to Radcliffe Medical Media. Only articles clearly marked with the CC BY-NC logo are published with the Creative Commons by Attribution Licence. The CC BY-NC option was not available for Radcliffe journals before 1 January 2019. Articles marked ‘Open Access’ but not marked ‘CC BY-NC’ are made freely accessible at the time of publication but are subject to standard copyright law regarding reproduction and distribution. Permission is required for reuse of this content.

Abstract

Mitral regurgitation (MR) is the most commonly found valvular lesion in echocardiography laboratories. Moderate and severe mitral regurgitation have proven to be associated with increased morbidity and mortality, and surgical reconstruction is recommended in severe cases whenever feasible. Three-dimensional echocardiography (3DE) is superior to conventional echocardiography in the detailed assessment of the specific anatomical features and the pathomechanism of MR, and in the accurate grading of its severity. 3DE is adept in detecting and quantifying geometric distortion of the mitral annulus and analysing valve mechanics. Segmental analysis of leaflet pathology is considerably facilitated and quantification software packages offer new parameters for tailored surgical repair techniques. Direct visualisation of the anatomic regurgitant orifice and calculations of the effective regurgitant orifice area by 3D colour Doppler techniques promise to circumvent the limitations of conventional echocardiography in the quantification of mitral regurgitation.

To view the full article, please click on the PDF icon.

References

  1. Singh JP, Evans JC, Levy D, et al., Prevalence and clinical determinants of mitral, tricuspid, and aortic regurgitation (the Framingham Heart Study), Am J Cardiol, 1999;83:897–902.
    Crossref | PubMed
  2. Enriquez-Sarano M, Akins CW, Vahanian A, Mitral regurgitation, Lancet, 2009;373:1382–94.
    Crossref | PubMed
  3. Enriquez-Sarano M, Timing of mitral valve surgery, Heart, 2002;87:79–85.
    Crossref | PubMed
  4. Yang HS, Bansal RC, Mookadam F, et al., Practical guide for three-dimensional transthoracic echocardiography using a fully sampled matrix array transducer, J Am Soc Echocardiogr, 2008;21:979–89.
    Crossref | PubMed
  5. Zamorano JL, Alberto de Augustín J, Three-dimensional Echocardiographic Evaluation of the Mitral Valve. In: Badano L, Lang RM, Zamorano JL, Textbook of Real-Time Three Dimensional Echocardiography, London, UK: Springer, 2011;55–8.
    Crossref
  6. Salcedo EE, Quaife RA, Seres T, Carroll JD, A framework for systematic characterization of the mitral valve by real-time three-dimensional transesophageal echocardiography, J Am Soc Echocardiogr, 2009;22:1087–99.
    Crossref | PubMed
  7. Lang RM, Badano LP, Tsang W, et al., EAE/ASE recommendations for image acquisition and display using three-dimensional echocardiography, J Am Soc Echocardiogr, 2012;25:3–46.
    Crossref | PubMed
  8. McCarthy KP, Ring L, Rana BS, Anatomy of the mitral valve: understanding the mitral valve complex in mitral regurgitation, Eur J Echocardiogr, 2010;11:i3–9.
    Crossref | PubMed
  9. Levine RA, Triulzi MO, Harrigan P, Weyman AE, The relationship of mitral annular shape to the diagnosis of mitral valve prolapse, Circulation, 1987;75:756–67.
    Crossref | PubMed
  10. Sonne C, Sugeng L, Watanabe N, et al., Age and body surface area dependency of mitral valve and papillary apparatus parameters: assessment by real-time three-dimensional echocardiography, Eur J Echocardiogr, 2009;10:287–94.
    Crossref | PubMed
  11. Salgo IS, Gorman JH 3rd, Gorman RC, et al., Effect of annular shape on leaflet curvature in reducing mitral leaflet stress, Circulation, 2002;106:711–7.
    Crossref | PubMed
  12. Ormiston JA, Shah PM, Tei C, Wong M, Size and motion of the mitral valve annulus in man. I. A two-dimensional echocardiographic method and findings in normal subjects, Circulation, 1981;64:113–20.
    Crossref | PubMed
  13. Kwan J, Jeon MJ, Kim DH, et al., Does the mitral annulus shrink or enlarge during systole? A real-time 3D echocardiography study, J Korean Med Sci, 2009;24:203–8.
    Crossref | PubMed
  14. Timek TA, Miller DC, Experimental and clinical assessment of mitral annular area and dynamics: what are we actually measuring?, Ann Thorac Surg, 2001;72:966–74.
    Crossref | PubMed
  15. Kovalova S, Necas J, RT-3D TEE: characteristics of mitral annulus using mitral valve quantification (MVQ) program, Echocardiography, 2011;28:461–7.
    Crossref | PubMed
  16. Kaplan SR, Bashein G, Sheehan FH, et al., Three-dimensional echocardiographic assessment of annular shape changes in the normal and regurgitant mitral valve, Am Heart J, 2000;139:378–87.
    Crossref | PubMed
  17. De Simone R, Wolf I, Mottl-Link S, et al., A clinical study of annular geometry and dynamics in patients with ischemic mitral regurgitation: new insights into asymmetrical ring annuloplasty, Eur J Cardiothorac Surg, 2006;29:355–61.
    Crossref | PubMed
  18. Grewal J, Suri R, Mankad S, et al., Mitral annular dynamics in myxomatous valve disease: new insights with real-time 3- dimensional echocardiography, Circulation, 2010;121:1423–31.
    Crossref | PubMed
  19. Little SH, Ben Zekry S, Lawrie GM, Zoghbi WA, Dynamic annular geometry and function in patients with mitral regurgitation: insight from three-dimensional annular tracking, J Am Soc Echocardiogr, 2010;23:872–9.
    Crossref | PubMed
  20. Pai RG, Varadarajan P, Tanimoto M, Effect of atrial fibrillation on the dynamics of mitral annular area, J Heart Valve Dis, 2003;12:31–7.
    PubMed
  21. Carpentier A, Cardiac valve surgery--the “French correction”, J Thorac Cardiovasc Surg, 1983;86:323–37.
    PubMed
  22. Buck T, Mitral Valve Quantification. In: Buck T, Franke A, Monaghan MJ, Three-dimensional Echocardiography, London, UK: Springer, 2010;116–20.
  23. Jassar AS, Brinster CJ, Vergnat M, et al., Quantitative mitral valve modeling using real-time three-dimensional echocardiography: technique and repeatability, Ann Thorac Surg, 2011;91:165–71.
    Crossref | PubMed
  24. Tsang W, Weinert L, Sugeng L, et al., The value of threedimensional echocardiography derived mitral valve parametric maps and the role of experience in the diagnosis of pathology, J Am Soc Echocardiogr, 2011;4:860–7.
    Crossref | PubMed
  25. Maffessanti F, Marsan NA, Tamborini G, et al., Quantitative analysis of mitral valve apparatus in mitral valve prolapse before and after annuloplasty: a three-dimensional intraoperative transesophageal study, J Am Soc Echocardiogr, 2011;24:405–13.
    Crossref | PubMed
  26. Ender J, Koncar-Zeh J, Mukherjee C, et al., Value of augmented reality-enhanced transesophageal echocardiography (TEE) for determining optimal annuloplasty ring size during mitral valve repair, Ann Thorac Surg, 2008;86:1473–8.
    Crossref | PubMed
  27. Becker AE, De Wit AP, Mitral valve apparatus. A spectrum of normality relevant to mitral valve prolapse, Br Heart J, 1979;42:680–9.
    Crossref | PubMed
  28. van der Bel-Kahn J, Duren DR, Becker AE, Isolated mitral valve prolapse: chordal architecture as an anatomic basis in older patients, J Am Coll Cardiol, 1985;5:1335–40.
    Crossref | PubMed
  29. Veronesi F, Corsi C, Sugeng L, et al., Quantification of mitral apparatus dynamics in functional and ischemic mitral regurgitation using real-time 3-dimensional echocardiography, J Am Soc Echocardiogr, 2008;21:347–54.
    Crossref | PubMed
  30. Shah PM, Raney AA, Echocardiography in mitral regurgitation with relevance to valve surgery, J Am Soc Echocardiogr, 2011;24:1086–91.
    Crossref | PubMed
  31. Adams DH, Anyanwu AC, The cardiologist’s role in increasing the rate of mitral valve repair in degenerative disease, Curr Opin Cardiol, 2008;23:105–10.
    Crossref | PubMed
  32. Chandra S, Salgo IS, Sugeng L, et al., A three-dimensional insight into the complexity of flow convergence in mitral regurgitation: adjunctive benefit of anatomic regurgitant orifice area, Am J Physiol Heart Circ Physiol, 2011;301:H1015–24.
    Crossref | PubMed
  33. Caiani EG, Fusini L, Veronesi F, et al., Quantification of mitral annulus dynamic morphology in patients with mitral valve prolapse undergoing repair and annuloplasty during a 6-month follow-up, Eur J Echocardiogr, 2011;12:375–83.
    Crossref | PubMed
  34. Pepi M, Tamborini G, Maltagliati A, et al., Head-to-head comparison of two- and three-dimensional transthoracic and transesophageal echocardiography in the localization of mitral valve prolapse, J Am Coll Cardiol, 2006;48:2524–30.
    Crossref | PubMed
  35. Tamborini G, Muratori M, Maltagliati A, et al., Pre-operative transthoracic real-time three-dimensional echocardiography in patients undergoing mitral valve repair: accuracy in cases with simple vs. complex prolapse lesions, Eur J Echocardiogr, 2010;11:778–85.
    Crossref | PubMed
  36. Gutierrez-Chico JL, Zamorano Gomez JL, Rodrigo-Lopez JL, et al., Accuracy of real-time 3-dimensional echocardiography in the assessment of mitral prolapse. Is transesophageal echocardiography still mandatory?, Am Heart J, 2008;155:694–8.
    Crossref | PubMed
  37. Macnab A, Jenkins NP, Bridgewater BJ, et al., Threedimensional echocardiography is superior to multiplane transoesophageal echo in the assessment of regurgitant mitral valve morphology, Eur J Echocardiogr, 2004;5:212–22.
    Crossref | PubMed
  38. Beraud AS, Schnittger I, Miller DC, Liang DH, Multiplanar reconstruction of three-dimensional transthoracic echocardiography improves the presurgical assessment of mitral prolapse, J Am Soc Echocardiogr, 2009;22:907–13.
    Crossref | PubMed
  39. Garcia-Orta R, Moreno E, Vidal M, et al., Three-dimensional versus two-dimensional transesophageal echocardiography in mitral valve repair, J Am Soc Echocardiogr, 2007;20:4–12.
    Crossref | PubMed
  40. Grewal J, Mankad S, Freeman WK, et al., Real-time threedimensional transesophageal echocardiography in the intraoperative assessment of mitral valve disease, J Am Soc Echocardiogr, 2009;22:34–41.
    Crossref | PubMed
  41. Wei J, Hsiung MC, Tsai SK, et al., The routine use of live three-dimensional transesophageal echocardiography in mitral valve surgery: clinical experience, Eur J Echocardiogr, 2010;11:14–8.
    Crossref | PubMed
  42. La Canna G, Arendar I, Maisano F, et al., Real-time threedimensional transesophageal echocardiography for assessment of mitral valve functional anatomy in patients with prolapse-related regurgitation, Am J Cardiol, 2011;107:1365–74.
    Crossref
  43. Biaggi P, Greutmann M, Crean A, Utility of three-dimensional transesophageal echocardiography: anatomy, mechanism, and severity of regurgitation in a patient with an isolated cleft posterior mitral valve, J Am Soc Echocardiogr, 2010;23:1114.
    Crossref | PubMed
  44. Jungwirth B, Adams DB, Mathew JP, et al., Mitral valve prolapse and systolic anterior motion illustrated by real time three-dimensional transesophageal echocardiography, Anesth Analg, 2008;107:1822–4.
    Crossref | PubMed
  45. O’Gara P, Sugeng L, Lang R, et al., The role of imaging in chronic degenerative mitral regurgitation, JACC Cardiovasc Imaging, 2008;1:221–37.
    Crossref | PubMed
  46. Fedak PW, McCarthy PM, Bonow RO, Evolving concepts and technologies in mitral valve repair, Circulation, 2008;117:963–74.
    Crossref | PubMed
  47. Delabays A, Jeanrenaud X, Chassot PG, et al., Localization and quantification of mitral valve prolapse using three-dimensional echocardiography, Eur J Echocardiogr, 2004;5:422–9.
    Crossref | PubMed
  48. Ahmed S, Nanda NC, Miller AP, et al., Usefulness of transesophageal three-dimensional echocardiography in the identification of individual segment/scallop prolapse of the mitral valve, Echocardiography, 2003;20:203–9.
    Crossref | PubMed
  49. Maslow AD, Regan MM, Haering JM, et al., Echocardiographic predictors of left ventricular outflow tract obstruction and systolic anterior motion of the mitral valve after mitral valve reconstruction for myxomatous valve disease, J Am Coll Cardiol ,1999;34:2096–104.
    Crossref | PubMed
  50. Adams DH, Anyanwu AC, Sugeng L, Lang RM, Degenerative mitral valve regurgitation: surgical echocardiography, Curr Cardiol Rep, 2008;10:226–32.
    Crossref | PubMed
  51. Bonow RO, Carabello BA, Kanu C, et al., ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): developed in collaboration with the Society of Cardiovascular Anesthesiologists: endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons, Circulation, 2006;114:e84–231
    Crossref | PubMed
  52. Vahanian A, Baumgartner H, Bax J, et al., Guidelines on the management of valvular heart disease: The Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology, Eur Heart J, 2007;28:230–68.
    Crossref | PubMed
  53. Chikwe J, Adams DH, Su KN, et al., Can three-dimensional echocardiography accurately predict complexity of mitral valve repair?, Eur J Cardiothorac Surg, 2012;41(3):518–24.
    Crossref | PubMed
  54. Tsukiji M, Watanabe N, Yamaura Y, et al., Three-dimensional quantitation of mitral valve coaptation by a novel software system with transthoracic real-time three-dimensional echocardiography, J Am Soc Echocardiogr, 2008;21(1):43–6 .
    Crossref | PubMed
  55. Silbiger JJ, Mechanistic insights into ischemic mitral regurgitation: echocardiographic and surgical implications, J Am Soc Echocardiogr, 2011;24:707–19.
    Crossref | PubMed
  56. Song JM, Fukuda S, Kihara T, et al., Value of mitral valve tenting volume determined by real-time three-dimensional echocardiography in patients with functional mitral regurgitation, Am J Cardiol, 2006;98:1088–93.
    Crossref | PubMed
  57. Chaput M, Handschumacher MD, Tournoux F, et al., Mitral leaflet adaptation to ventricular remodeling: occurrence and adequacy in patients with functional mitral regurgitation, Circulation, 2008;118:845–52.
    Crossref | PubMed
  58. Vergnat M, Jassar AS, Jackson BM, et al., Ischemic mitral regurgitation: a quantitative three-dimensional echocardiographic analysis, Ann Thorac Surg, 2011;91:157–64.
    Crossref | PubMed
  59. Izumo M, Lancellotti P, Suzuki K, et al., Three-dimensional echocardiographic assessments of exercise-induced changes in left ventricular shape and dyssynchrony in patients with dynamic functional mitral regurgitation, Eur J Echocardiogr, 2009;10:961–7.
    Crossref | PubMed
  60. Zhang L, Xie M, Balluz R, Ge S, Real time three-dimensional echocardiography for evaluation of congenital heart defects: state of the art, Echocardiography, 2012;29:232–41.
    Crossref | PubMed
  61. Fraisse A, Massih TA, Kreitmann B, et al., Characteristics and management of cleft mitral valve, J Am Coll Cardiol, 2003;42:1988–93.
    Crossref | PubMed
  62. Kondur A, Pitta S, Afonso L, Incremental utility of real-time three-dimensional echocardiography in the diagnosis and preoperative assessment of cleft mitral valve in adults, Eur J Echocardiogr, 2008;9:586–8.
    Crossref | PubMed
  63. Enriquez-Sarano M, Avierinos JF, Messika-Zeitoun D, et al., Quantitative determinants of the outcome of asymptomatic mitral regurgitation, N Engl J Med, 2005;352:875–83.
    Crossref | PubMed
  64. Lancellotti P, Moura L, Pierard LA, et al., European Association of Echocardiography recommendations for the assessment of valvular regurgitation. Part 2: mitral and tricuspid regurgitation (native valve disease), Eur J Echocardiogr, 2010;11:307–32.
    Crossref | PubMed
  65. Khanna D, Vengala S, Miller AP, et al., Quantification of mitral regurgitation by live three-dimensional transthoracic echocardiographic measurements of vena contracta area, Echocardiography, 2004;21:737–43.
    Crossref | PubMed
  66. Kahlert P, Plicht B, Schenk IM, et al., Direct assessment of size and shape of noncircular vena contracta area in functional versus organic mitral regurgitation using real-time three-dimensional echocardiography, J Am Soc Echocardiogr, 2008;21:912–21.
    Crossref | PubMed
  67. Zeng X, Levine RA, Hua L, et al., Diagnostic value of vena contracta area in the quantification of mitral regurgitation severity by color Doppler 3D echocardiography, Circ Cardiovasc Imaging, 2011;4:506–13.
    Crossref | PubMed
  68. Little SH, Pirat B, Kumar R, et al., Three-dimensional color Doppler echocardiography for direct measurement of vena contracta area in mitral regurgitation: in vitro validation and clinical experience, JACC Cardiovasc Imaging, 2008;1:695–704.
    Crossref | PubMed
  69. Marsan NA, Westenberg JJ, Ypenburg C, et al., Quantification of functional mitral regurgitation by real-time 3D echocardiography: comparison with 3D velocity-encoded cardiac magnetic resonance, JACC Cardiovasc Imaging, 2009;2:1245–52.
    Crossref | PubMed
  70. Buck T, Mucci RA, Guerrero JL, et al., The power-velocity integral at the vena contracta: A new method for direct quantification of regurgitant volume flow, Circulation, 2000;102:1053–61.
    Crossref | PubMed
  71. Skaug TR, Hergum T, Amundsen BH, et al., Quantification of mitral regurgitation using high pulse repetition frequency three-dimensional color Doppler, J Am Soc Echocardiogr, 2010;23:1–8.
    Crossref | PubMed
  72. Plicht B, Kahlert P, Goldwasser R, et al., Direct quantification of mitral regurgitant flow volume by real-time threedimensional echocardiography using dealiasing of color Doppler flow at the vena contracta, J Am Soc Echocardiogr, 2008;21:1337–46.
    Crossref | PubMed
  73. Coisne D, Erwan D, Christiaens L, et al., Quantitative assessment of regurgitant flow with total digital threedimensional reconstruction of color Doppler flow in the convergent region: in vitro validation, J Am Soc Echocardiogr, 2002;15:233–40.
    Crossref | PubMed
  74. Yosefy C, Levine RA, Solis J, et al., Proximal flow convergence region as assessed by real-time 3-dimensional echocardiography: challenging the hemispheric assumption, J Am Soc Echocardiogr, 2007;20:389–96.
    Crossref | PubMed
  75. Matsumura Y, Saracino G, Sugioka K, et al., Determination of regurgitant orifice area with the use of a new threedimensional flow convergence geometric assumption in functional mitral regurgitation, J Am Soc Echocardiogr, 2008;21:1251–6.
    Crossref | PubMed
  76. Cobey FC, McInnis JA, Gelfand BJ, et al., A method for automating 3-dimensional proximal isovelocity surface area measurement, J Cardiothorac Vasc Anesth, 2012;26(3):507–11.
    Crossref | PubMed
  77. Grady L, Datta S, Kutter O, et al., Regurgitation quantification using 3D PISA in volume echocardiography. Proceedings of the 14th international conference on Medical image computing and computer-assisted intervention - Volume Part III, Toronto, Canada: Springer-Verlag, 2011;512–9.
    Crossref | PubMed
  78. Goncalves A, Zamorano JL, Valve anatomy and function with transthoracic three-dimensional echocardiography: advantages and limitations of instantaneous full-volume color Doppler imaging, Ther Adv Cardiovasc Dis, 2010;4:385–94.
    Crossref | PubMed
Previous Volume Article Next Volume Article