Three-dimensional echocardiographic planimetry of maximal regurgitant orifice are in myxomatous mitral regurgitation: intraoperative comparison with proximal flow convergence

Objectives. We sought to validate direct planimetry of mitral regurgitant orifice are from three-dimensional echocardiographic reconstructions. Background. Regurgitant orifice are (ROA) is an important measure of the severity of mitral regurgitation (MR) that up to now has been calculated from hemodynamic dat rather than measured directly. We hypothesized that improved spatial resolution of the mitral valve (MV) with three-dimensional (3D) echo might allow accurate planimetry of ROA. Methods. We reconstructed the MV using 3D echo with 3° rotational acquisitions (TomTec) using transesophageal (TEE) multiplane probe in 15 patients undergoing MV repair (age 59 ± 11 years). One observer reconstructed the prolapsing mitral leaflet in left atrial plane parallel to the RO and planimetered the two-dimensional (2D) projection of the maximal ROA. second observer, blinded to the results of the first, calculated maximal RO using the proximal convergence method defined as maximal flow rate (2πr2va, where r is the radius of color alias contour with velocity va) divided by regurgitant peak velocity (obtained by continuous wave [CW] Doppler) and corrected as necessary for proximal flow constraint. Results. Maximal RO was 0.79 ± 0.39 (mean ± SD) cm2 by 3D and 0.86 ± 0.42 cm2 by proximal convergence (p = NS). Maximal RO by 3D echo (y) was highly correlated with the corresponding flow measurement (x) (y = 0.87x + 0.03, r = 0.95, p < 0.001) with close agreement seen (ΔRO (y − x) = 0.07 ± 0.12 cm2). Conclusions. 3D echo imaging of the MV allows direct visualization and planimetry of the RO in patients with severe MR with good agreement to flow-based proximal convergence measurements.