Page 16 - Advanced echocardiography in characterization and management of patients with secondary mitral regurgitation

Chapter one. General introduction and outline of thesis
Furthermore, three-dimensional transesophageal echocardiography has shown good agreement with CMR to quantify the effective regurgitant orifice area and the regurgitant volume [8–11]. Postprocessing of the three-dimensional color Doppler data using multiplanar reformation planes permits the measurement of the three- dimensional vena contracta and the anatomic regurgitant orifice area (Fig. 4). Choi et al.[12] compared mitral regurgitation quantification with the two-dimensional and three-dimensional echocardiographic proximal isovelocity surface area (PISA) methods and demonstrated that the two-dimensional PISA method significantly underestimated the mitral regurgitant volume compared with the three-dimensional PISA method (52.4 ± 19.6 ml versus 59.5 ± 25.6 ml; P = 0.005). In addition, in the subgroup of individuals with CMR data, the mitral regurgitant volume obtained by three-dimensional PISA method showed a better agreement with phase-contrast CMR than two-dimensional PISA (r = 0.97 versus 0.84, respectively).
Figure 3: Examples of three-dimensional transe- sophageal echocardiogra- phy images of patients with suitable anatomy for various transcatheter interventions. Panels a and b demonstrate a patient suitable for cardio- band, with mitral regurgita- tion caused by annulus di- lation (annulus area of 11.4 cm2). Panels c and d demon- strate a patient suitable for Neochord, with primary mi- tral regurgitation because of
prolapse of the central scallop of the posterior mitral leaflet and enough leaflet length (anterior leaflet length of 2.0 cm and posterior leaflet length of 2.1 cm). Panels e and f demonstrate a pa- tient with secondary mitral regurgitation with suitable anatomy for edge-to-edge therapy device (tenting height of 1.0 cm and anterior and posterior leaflet length of 2.6 and 1.6 cm, respectively).
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