Three-Dimensional Modelling of Indexed Papillary Muscle Displacement in Patients Requiring Mitral Valve Surgery Using Four-Dimensional Echocardiography Variables

Figure 1. Alignment of “points” and “lines” to mitral valve—view of the mitral valve in the QLAB 13R software. The line in green marks the position of the left atrium and the left ventricle. The points demarcate the position of the mitral annulus, aortic annulus, anterior point, and coaptation/valve closure. There is a total of 7 points and 2 lines under “View Adjustment”, which need to be adjusted according to the reference provided at the left side. During the adjustment, it is allowed to pause at a single frame, which is helpful for placing the points and lines in their respective positions more accurately. After finishing the “View Adjustment”, it proceeds to “Static Model Review”. A = anterior point, AA = aortic annulus, CL = coaptation/valve closure, MA = mitral annulus, LA = left atrium, LV = left ventricle, LAX = long axis, SAX = short axis.

Figure 2. “Static Model Review” shows a static model of the mitral valve generated using QLAB 13R software showing the anterior and posterior leaflets. The lines are adjusted according to the reference found at the left under the “Static Model Review”. There are two views provided, which are annulus and coaptation views. For the two views, it is important to ensure that the line is aligned with the mitral valve. A1, A2, A3 = anterior leaflet, P1, P2, P3 = posterior leaflet, SAX = short axis.

Figure 3. “Dynamic Model Review” shows alignment in the generated dynamic model review—this provides the visualization of both annulus and coaptation once the “Static Model Review” is completed. Both the “Static Model Review” and “Dynamic Model Review” play an important role in the visualization of the valvular complex and its geometric properties. A1, A2, A3 = anterior leaflet, P1, P2, P3 = posterior leaflet, SAX = short axis.

Figure 4. Analysis of the final outcome of the generated measurements of the mitral valve—at the end of each analysis, complete measurements are automatically calculated. These are height of the leaflets and coaptation length, anteroposterior diameter, anterolateral–posteromedial diameter, sphericity index, non-planar angle, annulus circumference, annulus area (2D), annulus area (3D), and annulus height of the mitral valve estimated using the QLAB 13R software. The measurements can be exported in 2 types of files: DICOM SR and .txt format. AL-PM = anterolateral-posteromedial, AP = anteroposterior.