Abstract 13143: Direct Measurement of Multiple Vena Contracta Areas by Real-time three-dimensional Echocardiography for Assessing Severity of Mitral Regurgitation
Background: A standard semi-quantitative measure of mitral regurgitation (MR) severity is the diameter of the jet vena contracta (VC). Because of the conflicting requirements of Doppler versus imaging physics, the measurement of this parameter is difficult and has not been validated for multiple MR jets. Real-time 3-dimensinal (3D) echocardiographic measurement of VC area has been validated in patients with a single jet of MR and correlated well with the MR severity. The purpose of this study was to determine whether direct measurement of multiple VC areas by real-time 3D transesophageal echocardiography (3DTEE) is a feasible and accurate Methods of measuring MR severity in patients with multiple MR jets.
Methods: 3DTEE was performed in 38 patients with multiple functional MR jets. MR severity was assessed using the pulsed Doppler quantitative flow method of deriving effective regurgitant area (EROAdopp): (mitral diastolic stroke volume minus aortic systolic stroke volume) / MR velocity time integral. Manual tracings of multiple 3D VC areas in a cross-sectional plane through the VC from the mid-esophageal view were obtained and the sum of the areas (3DVCarea) was compared with EROAdopp. Likewise, 2D VC diameters were measured from TEE views optimizing imaging of multiple jets. The diameters of the jets were summed (2DVCdiam) and compared to EROAdopp.
Results: 3DVCarea correlated well with EROAdopp (r=0.85, P<0.01); the relation was stronger than for 2DVCdiam (r=0.70, P<0.01). 3DVCarea correlated better with EROAdopp compared to 2DVCdiam with MR degrees greater than mild (r=0.79, P<0.01 vs r=0.45, P=0.14) and in case of three or more regurgitant jets (r=0.94, P<0.01, vs r=0.33, P=0.44).
Conclusions: The direct measurement of multiple VC areas using 3DTEE is feasible and provides a simple parameter that accurately reflects MR severity, particularly in MR degrees greater than mild and in case of multiple regurgitant jets, where geometric assumptions may be challenging.
- © 2010 by American Heart Association, Inc.