Comparison of biplanar- with 3D-vena contracta and vena contracta area for the assessment of tricuspid valve regurgitation by intraoperative transesophageal echocardiography.
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引用次数: 0
Abstract
Background: Tricuspid regurgitation (TR) is often incidentally detected at intraoperative transesophageal echocardiography (TEE), resulting in possible changes in the surgical plan. The aim of this study was to compare 2D and 3D measurements of TR vena contracta width (VCW) and the degree of TR severity using TEE from the three standard mid-esophageal (ME) views.
Methods: In a prospective observational study, we analyzed 3D and 2D TEE datasets from 30 adult patients undergoing elective tricuspid valve (TV) repair. 2D and 3D TEE color flow Doppler (CFD) loops of the TV in the three standard ME views (4Chamber, RV inflow-outflow (inflow) and modified bicaval) were recorded immediately after induction of anesthesia. VCW from single views and the average of the measurement of biplane VCW (2D biplane VCW) from each standard view were compared with the maximum and minimum diameters of the 3D vena contracta area (VCA) and their average (3D average VCW). TR severity classification was compared between 2D biplane VCW and 3D average VCW and VCA. Correlation between measurements was analyzed using Pearson coefficient and agreement assessed using the Bland-Altman method. Cohen's Kappa correlation was used to assess TR severity concordance.
Results: Biplane VCW in all three ME views underestimated 3D average VCW measurement, with VCW from ME inflow view showing the best agreement. VCW measurements in single standard views systematically underestimated the maximum 3D VCA diameter. We detected very good agreement in TR grading between 3D average VCW and 3D VCA, and an underestimation by 2D biplane VCW (moderate agreement for inflow and fair for the other views). Intra- and inter-observer correlation when repeating 2D measurements was more reliable than that for 3D measurements.
Conclusions: Our study shows that 2D biplane VCW from the ME inflow view best agrees with 3D average VCW and allows the most accurate classification of TR severity compared to 3D average VCW.
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