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CLINICAL STUDY: NEW METHODS

Improved assessment of mitral valve stenosis by volumetric real-time three-dimensional echocardiography

^a Department of Cardiology, University of Vienna, Austria
^b Ludwig Boltzmann Institute, Austria

Manuscript received May 20, 1999; revised manuscript received January 17, 2000, accepted March 2, 2000.

Reprint requests and correspondence: Dr. Thomas Binder, Dept. of Cardiology, University of Vienna, Währingergürtel 18- 20, A-1090 Vienna, Austria
thomas.binder{at}univie.ac.at

OBJECTIVES

This study was performed to determine the feasibility, accuracy and reproducibility of real-time volumetric three-dimensional echocardiography (3-D echo) for the estimation of mitral valve area in patients with mitral valve stenosis.

BACKGROUND

Planimetry of the mitral valve area (MVA) by two-dimensional echocardiography (2-D echo) requires a favorable parasternal acoustic window and depends on operator skill. Transthoracic volumetric 3-D echo allows reconstruction of multiple 2-D planes in any desired orientation and is not limited to parasternal acquisition, and could thus enhance the accuracy and feasibility of calculating MVA.

METHODS

In 48 patients with mitral stenosis (40 women; mean age 61 ± 13 years) MVA was determined by planimetry using volumetric 3-D echo and compared with measurements obtained by 2-D echo and Doppler pressure half-time (PHT). All measurements were performed by two independent observers. Volumetric data were acquired from an apical view.

RESULTS

Although 2-D echo allowed planimetry of the mitral valve in 43 of 48 patients (89%), calculation of the MVA was possible in all patients when 3-D echo was used. Mitral valve area by 3-D echo correlated well with MVA by 2-D echo (r = 0.93, mean difference, 0.09 ± 0.14 cm²) and by PHT (r = 0.87, mean difference, 0.16 ± 0.19 cm²). Interobserver variability was significantly less for 3-D echo than for 2-D echo (SD 0.08cm² versus SD 0.23cm², p < 0.001). Furthermore, it was much easier and faster to define the image plane with the smallest orifice area when 3-D echo was used.

CONCLUSIONS

Transthoracic real-time volumetric 3-D echo provides accurate and highly reproducible measurements of mitral valve area and can easily be performed from an apical approach.

Abbreviations and Acronyms   MVA = mitral valve area   Echo = echocardiography   PHT = pressure half-time   2-D = two-dimensional   3-D = three-dimensional   SD = standard deviation

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