Geometric Errors of the Pulsed-Wave Doppler Flow Method in Quantifying Degenerative Mitral Valve Regurgitation: A Three-Dimensional Echocardiography Study

Claire Ren, Lotte Laat, J McGhie, Wim Vletter, Folkert ten Cate, Marcel Geleijnse

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Background: The aim of this study was to estimate geometric errors made by the two-dimensional (2D) transthoracic echocardiographic (TTE) pulsed-wave Doppler flow (PWDF) method in calculating regurgitant volume (RVol) and effective regurgitant orifice area (EROA) in degenerative mitral regurgitation (MR) by comparison with the three-dimensional (3D) transesophageal echocardiographic (TEE) PWDF method. Methods: RVol and EROA were calculated in 22 patients with degenerative MR using the conventional 2D TTE PWDF method on the basis of monoplanar dimensions and a circular geometric assumption of the cross-sectional areas (CSAs) of the mitral annulus (MA) and the left ventricular outflow tract (LVOT) and the 3D TEE PWDF method, in which the CSAs of the MA and LVOT were measured directly in "en face" views. Diameters of the MA and LVOT were also measured in similar views as with TTE imaging in 3D T Results: Both the MA and LVOT were oval. Mean MA diameters were 41 +/- 4 mm (3D TEE major axis), 31 +/- 4 mm (3D TEE minor axis), 39 +/- 5 mm (2D TTE imaging), and 38 +/- 5 mm (2D TEE imaging). Mean LVOT diameters were 29 +/- 4 mm(3D TEE major axis), 21 +/- 2 mm (3D TEE minor axis), 22 +/- 2 mm(2D TTE imaging), and 23 +/- 2 mm (2D TEE imaging). Compared with 3D TEE measurements, mitral annular CSA was overestimated by 13 +/- 12% on 2D TTE imaging and by 7 +/- 14% on 2D TEE imaging, while LVOT CS Conclusions: The 2D TTE PWDF method overestimates mitral RVol and EROA significantly because monoplanar 2D measurements represent mitral annular major-axis diameter and LVOT minor-axis diameter, and assumed circular CSAs of the MA and LVOT are oval. (J Am Soc Echocardiogr 2013;26:261-9.)
Original languageUndefined/Unknown
Pages (from-to)261-269
Number of pages9
JournalJournal of the American Society of Echocardiography
Issue number3
Publication statusPublished - 2013

Research programs

  • EMC COEUR-09

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