Adaptive Color Gain for Vena Contracta Quantification in Valvular Regurgitation

Aims Evaluation of eccentric mitral regurgitation (MR) remains extremely difficult and the role played by its etiology, functional or degenerative, is not well understood. This study aimed to demonstrate the value of three‐dimensional transesophageal echocardiography (3DTEE) in the evaluation of eccentric MR identifying geometric differences in the vena contracta area between functional and degenerative etiologies. Methods and Results We studied 61 patients with eccentric MR (30 functional and 31 degenerative). Regurgitant orifice area was determined by the two‐dimensional proximal isovelocity surface area (2DPISA) and the 3DTEE methods. The ratio between maximum and minimum lengths of the vena contracta was calculated in each patient. Effective regurgitant orifice area by the 2DPISA method was smaller than that estimated by 3DTEE (0.56±0.21 vs 0.72±0.25 cm 2 ). A better correlation between both methods was seen in degenerative mitral regurgitation (DMR; r =.83), with a mean underestimation of 8.2% by the 2DPISA method. A much worse correlation was found in functional mitral regurgitation (FMR; r =.39), where a mean underestimation by the 2DPISA method of 29.1% was observed. There was a more elongated and curved vena contracta in FMR compared to that in DMR (length ratio: 3.4±1.0 vs 2.2±0.7, P <.0001). Conclusion Three‐dimensional transesophageal echocardiography identifies a more elongated regurgitant orifice in eccentric FMR compared to that in eccentric DMR. This difference may explain the greater underestimation of effective regurgitant orifice area by the 2DPISA method in FMR. High‐quality 3DTEE analysis of vena contracta area would be a highly recommended alternative.

Vena contracta

Color doppler

10.1111/echo.13508

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Citations (10)

Three-dimensional segmentation and quantification of the anatomic regurgitant orifice in mitral regurgitation using 3D ultrasound images

2019 Computing in Cardiology Conference (CinC) (2015)

Miguel Sotaquirá Mauro Pepi Gloria Tamborini Enrico G. Caiani

Currently, clinical assessment of mitral regurgitation (MR) makes the use of 2D color Doppler imaging for the estimation of the vena contracta (VC) and of the effective regurgitant orifice area (EROA)..Since the anatomic regurgitant orifice (ARO) has a 3D shape and it's not circular, it cannot be accurately represented by these 2D parameters. We developed a novel semiautomated method for 3D ARO segmentation and quantification using 3D transesophageal echocardiographic (TEE) datasets, and validated it vs manual planimetry on a set of 25 patients with mild to severe MR. ARO 2D projected area and circularity index (CI) correlated well with planimetry results (r2=0.77 and 0.90 and bias of -0.02 and 0.02, respectively). In 19/25 patients ARO planarity index was less than 0.9, confirming its 3D morphology. Only 1/25 patients exhibited an almost circular ARO (CI > 0.92), while 24/25 patients had more elongated orifices (CI<;0.8). In conclusion, volumetric quantification of 3D ARO is feasible, and the results confirm the potential of this technique for the estimation of real 3D ARO shape. The proposed method could be a useful alternative for the assessment of patients with MR, given the intrinsic shape of the ARO and the limitations present in current approaches.

Vena contracta

3D ultrasound

Color doppler

3d model

10.1109/cic.2015.7408574

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Citations (1)

Role of 3DE in Assessment of Functional Mitral Regurgitation

Springer eBooks (2021)

Joseph F. Maalouf Francesco F. Faletra

Vena contracta

Color doppler