Vena contracta area measurement by three-dimensional echocardiography for assessing mitral regurgitation severity using a novel, fast, and reliable method.

Abstract

Background: Echocardiography is the standard tool for the evaluation of mitral regurgitation (MR). Although Two-dimensional echocardiography is the most recommended tool, it has some limitations. Three-dimensional echocardiography (3DE) is suggested to overcome these limitations, however, it is more time-consuming. Introducing a simplified and accurate 3-D method could be helpful in this regard.

Methods: Patients diagnosed with significant MR who were referred to Shahid Madani heart center, Tabriz, Iran for evaluation of MR severity were entered in this study. Patients with prior MR surgery, poor image quality, and without self-consent for participation in the study were excluded. Two-dimensional transthoracic echocardiography (TTE) and 3D transesophageal echocardiography (TEE) were performed in all patients. MR severity was compared between these two methods and between direct planimetry (DP) of the vena contracta area (VCA) and 3D directed multiplanar reconstruction (MPR).

Results: A total of 53 patients were studied. Thirty-six (69.7%) of the patients were female. The mean age of patients was 66.21 ± 11.91 years. 3DVCA using DP was significantly correlated with the 2D method in terms of MR severity (p = 0.006). There was a significant correlation between the results of 3DE DP and 2DE magnetic resonance voiding cystography (MRVC) diameter (r = 0.503 and p = 0.0001). A significant correlation was also found between the result of DP and MPR-derived VCA using 3D (r = 0.97 and p = 0.0001).

Conclusion: TEE is an invaluable method to decide the severity and mechanism of patients with MR, especially if TTE does not give adequate information. The method proposed in this study for evaluation of MR severity and mechanism using 3D TEE could be a helpful option, especially in the above-mentioned conditions. In this study, 3D direct planimetry had an acceptable correlation with 2DE MRVC and also with 3D MPR-derived VCA.