Key result
The novel 3D orifice area method yielded significantly smaller post-repair mitral valve areas compared to 2D planimetry (mean difference 1.26 cm, P<0.0001) and other conventional methods.
Why the study?
Available 2D echocardiographic methods for assessing mitral valve orifice area after MVr are limited by complex 3D geometry.
Does the novel 3DOA method yield different mitral valve area measurements compared to conventional 2D and 3D echocardiographic methods in adult patients after mitral valve repair?
Observational (n=20)
Does the novel 3DOA method yield different mitral valve area measurements compared to conventional 2D and 3D echocardiographic methods in adult patients after mitral valve repair?
A novel 3D orifice area echocardiographic method yields significantly smaller mitral valve area measurements post-repair compared to conventional 2D and 3D techniques, potentially identifying more cases of significant MVA reduction.
BACKGROUND: Currently available 2-dimensional (2D) echocardiographic methods for accurately assessing the mitral valve orifice area (MVA) after mitral valve repair (MVr) are limited due to its complex 3-dimensional (3D) geometry. We compared repaired MVAs obtained with commonly used 2D and 3D echocardiographic methods to a 3D orifice area (3DOA), which is a novel echocardiographic measurement and independent of geometric assumptions. METHODS: Intraoperative 2D and 3D transesophageal echocardiography (TEE) images from 20 adult cardiac surgery patients who underwent MVr for mitral regurgitation obtained immediately after repair were retrospectively reviewed. MVAs obtained by pressure half-time (PHT), 2D planimetry (2DP), and 3D planimetry (3DP) were compared to those derived by 3DOA. RESULTS: MVAs (mean value ± standard deviation [SD]) after MVr were obtained by PHT (3 ± 0.6 cm), 2DP (3.58 ± 0.75 cm), 3D planimetry (3DP; 2.78 ± 0.74 cm), and 3DOA (2.32 ± 0.76 cm). MVAs obtained by the 3DOA method were significantly smaller compared to those obtained by PHT (mean difference, 0.68 cm; P = .0003), 2DP (mean difference, 1.26 cm; P < .0001), and 3DP (mean difference, 0.46 cm; P = .003). In addition, MVA defined as an area ≤1.5 cm was identified by 3DOA in 2 patients and by 3DP in 1 patient. CONCLUSIONS: Post-MVr MVAs obtained using the novel 3DOA method were significantly smaller than those obtained by conventional echocardiographic methods and may be consistent with a higher incidence of MVA reduction when compared to 2D techniques. Further studies are still needed to establish the clinical significance of 3D echocardiographic techniques used to measure MVA after MVr.
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Karamnov et al. (2019) conducted an observational in Mitral regurgitation (n=20). 3D orifice area (3DOA) echocardiographic method vs. Pressure half-time (PHT), 2D planimetry (2DP), and 3D planimetry (3DP) was evaluated on Mitral valve orifice area (MVA) (MD 1.26, p=<.0001). The novel 3D orifice area method yielded significantly smaller post-repair mitral valve areas compared to 2D planimetry (mean difference 1.26 cm, P<0.0001) and other conventional methods.
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