Three‐Dimensional Transesophageal Echocardiographic Vena Contracta Area for Grading Mitral Regurgitation: Severity Cut‐offs From a Prospective Tunisian Cohort

Background Mitral regurgitation (MR) is among the most common valvular heart diseases, but its echocardiographic quantification remains challenging, particularly in secondary MR and in some organic causes. Three‐dimensional vena contracta area (3D VCA) allows direct planimetry of the regurgitant orifice. We aim to compare 3D VCA with two‐dimensional (2D) parameters and to derive aetiology‐specific severity cut‐offs in a Tunisian cohort. Methods Prospective cross‐sectional study. Patients with at least moderate MR underwent transthoracic and 2D/3D transesophageal echocardiography with planimetry of the VCA. Spearman correlations between 3D VCA and 2D parameters (vena contracta width, PISA‐derived regurgitant orifice area), and diagnostic performance for severe MR (ROC, Youden index), were analyzed. Results Ninety‐seven patients were included (mean age 61.6 ± 12.5 years; sex ratio 1.1). MR was primary in 66% (rheumatic 34%, degenerative 31%) and secondary in 34%; jets were mostly single, eccentric and holosystolic, and 62.9% had severe MR. 3D VCA correlated strongly with PISA‐derived orifice area (rho = 0.78) and with vena contracta width (rho = 0.65), particularly in organic, rheumatic, degenerative and eccentric MR. 3D VCA and 2D orifice area identified severe MR with an area under the curve of 0.93; the optimal 3D VCA cut‐off was 0.43 cm 2 overall, 0.42 cm 2 (rheumatic), 0.55 cm 2 (degenerative) and 0.39 cm 2 (secondary). Conclusion 3D VCA reliably quantifies MR, provides aetiology‐specific cut‐offs and outperforms 2D methods in complex jets. Multicenter validation is needed, particularly in rheumatic‐endemic regions.