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Three-Dimensional Color Doppler Echocardiography for Direct Measurement of Vena Contracta Area in Mitral Regurgitation

In Vitro Validation and Clinical Experience

Stephen H. Little, MD, FACC^_*, Bahar Pirat, MD^_*, Rahul Kumar, MD^_*, Stephen R. Igo, BSc, Marti McCulloch, BSc^_*, Craig J. Hartley, PhD, Jiaqiong Xu, PhD, William A. Zoghbi, MD, FACC^_*,_*

^_* The Methodist DeBakey Heart and Vascular Center, Houston, Texas
The Methodist Hospital Research Institute, Houston, Texas
Baylor College of Medicine, Houston, Texas

^_* Reprint requests and correspondence: Dr. William A. Zoghbi, Methodist DeBakey Cardiovascular Imaging Institute, 6550 Fannin, SM-677, Houston, Texas 77030 (Email: wzoghbi{at}tmhs.org).

Objectives: Our goal was to prospectively compare the accuracy of real-time three-dimensional (3D) color Doppler vena contracta (VC) area and two-dimensional (2D) VC diameter in an in vitro model and in the clinical assessment of mitral regurgitation (MR) severity.

Background: Real-time 3D color Doppler allows direct measurement of VC area and may be more accurate for assessment of MR than the conventional VC diameter measurement by 2D color Doppler.

Methods: Using a circulatory loop with an incorporated imaging chamber, various pulsatile flow rates of MR were driven through 4 differently sized orifices. In a clinical study of patients with at least mild MR, regurgitation severity was assessed quantitatively using Doppler-derived effective regurgitant orifice area (EROA), and semiquantitatively as recommended by the American Society of Echocardiography. We describe a step-by-step process to accurately identify the 3D-VC area and compare that measure against known orifice areas (in vitro study) and EROA (clinical study).

Results: In vitro, 3D-VC area demonstrated the strongest correlation with known orifice area (r = 0.92, p < 0.001), whereas 2D-VC diameter had a weak correlation with orifice area (r = 0.56, p = 0.01). In a clinical study of 61 patients, 3D-VC area correlated with Doppler-derived EROA (r = 0.85, p < 0.001); the relation was stronger than for 2D-VC diameter (r = 0.67, p < 0.001). The advantage of 3D-VC area over 2D-VC diameter was more pronounced in eccentric jets (r = 0.87, p < 0.001 vs. r = 0.6, p < 0.001, respectively) and in moderate-to-severe or severe MR (r = 0.80, p < 0.001 vs. r = 0.18, p = 0.4, respectively).

Conclusions: Measurement of VC area is feasible with real-time 3D color Doppler and provides a simple parameter that accurately reflects MR severity, particularly in eccentric and clinically significant MR where geometric assumptions may be challenging.

Key Words: mitral valve • regurgitation • color Doppler • 3D echocardiography • vena contracta

Abbreviations and Acronyms   2D = two-dimensional   3D = three-dimensional   AP = apical (or apical equivalent)   CD = color Doppler   EROA = effective regurgitant orifice area   MR = mitral regurgitation   PS = parasternal (or parasternal equivalent)   VC = vena contracta

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