The impact of different geometric assumption of mitral annulus on the assessment of mitral regurgitation volume by Doppler method

Figures

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  Fig. 1. QPD calculations of MRvol assuming that the MA is ellipse geometry. a The diameter of LVOT was measured in the PLAX view, and the CSALVOT was derived as 0.785 d2. d LVOT pulsed Doppler was traced to obtain the VTILVOT. Thus, SVLVOT = 0.785 d2 × VTILVOT = 0.785 × 2.082 × 13.4 = 45.51 ml. b and c The diameter of MA was measured in the A4C and A2C view. The CSAMA was derived as 0.785 × a × b. e MA inflow pulsed Doppler was traced to obtain the VTIMA. Thus, SVMA = 0.785 × a × b × VTIMA = 0.785 × 3.33 × 2.65 × 13.1 = 90.75 ml. In this example of MR, MRvol = SVMA - SVLVOT = 90.75–45.51 = 45.24 ml

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  Fig. 2. QPD calculations of MRvol assuming that the MA is circular geometry. a The diameter of LVOT was measured in the PLAX view, and the CSALVOT was derived as 0.785 d2. d LVOT pulsed Doppler was traced to obtain the VTILVOT. Thus, SVLVOT = 0.785 d2 × VTILVOT = 0.785 × 1.962 × 28.8 = 86.85 ml. b and c The diameter of MA was measured in the A4C and A2C view. The CSAA4C was derived as 0.785 × 3.22, and CSAA2C was derived as 0.785 × 2.712. e MA inflow pulsed Doppler was traced to obtain the VTIMA. Thus, SVA4C = 0.785 × 3.22 × 19.2 = 154.33 ml, and SVA2C = 0.785 × 2.712 × 19.2 = 110.69 ml. In this example of MR, MRvol by QPD-MAA4C = SVA4C - SVLVOT = 154.33–86.85 = 67.48 ml, and MRvol by QPD-MAA2C = 110.69–86.85 = 23.84 ml

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  Fig. 3. MRvol calculated as EROA by RT3DE multiplied by the VTIMR. The 3D color Doppler data was manually cropped by the cross-sectional plane perpendicularly to the regurgitant jet direction up to the smallest cross-sectional area of the regurgitant jet. The EROA was determined using manual planimetry of the color Doppler flow signal from an en face view. Example of a MR patient: EROA = 0.28 cm2, VTIMR = 150 cm, MRvol = 0.28 × 150 = 42 mL

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  Fig. 4. Assumption of a circular geometry of MA, linear regression plot and Bland-Altman plot showing correlations (a) and agreement (b) between MRvol by QPD-MAA4C and RT3DE

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  Fig. 5. Assumption of a circular geometry of MA, linear regression plot and Bland-Altman plot showing correlations (a) and agreement (b) between MRvol by QPD-MAA2C and RT3DE

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  Fig. 6. Assumption of an ellipse geometry of MA, linear regression plot and Bland-Altman plot showing correlations (a) and agreement (b) between MRvol by QPD-MAA4C + A2C and RT3DE