Three-dimensional echocardiographic planimetry of maximal regurgitant orifice area in myxomatous mitral regurgitation: intraoperative comparison with proximal flow convergence
Christian S. Breburda, MD*,a,
Brian P. Griffin, MD, FACCa,
Min Pu, MDa,
Leonardo Rodriguez, MDa,
Delos M. Cosgrove, III, MDa and
James D. Thomas, MD, FACCa
a Cardiovascular Imaging Center, Department of Cardiology, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
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Figure 1 Three-dimensional visualization of a flail posterior leaflet. The vantage is of an observer on the anterior mitral annulus looking posterior toward the posterior mitral leaflets, which is flail in its middle scallop. LA = left atrium; LV = left ventricle; PL = posterior leaflet. Medial and Lateral = respective mitral commissures.
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Figure 2 Flail posterior leaflet (transesophageal view) demonstrating proximal flow convergence with wall constraint because of the proximetry of the posterior wall. To adjust for the predictable overestimation due to this geometric distortion, regurgitant flow rate and orifica area are adjusted by  /180. LA = left atrium; LV = left ventricle.
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Figure 3 Regression analysis relating effective ROA calculated by flow convergence and planimetered regurgitant orifice area by 3D echocardiography. (r = 0.95; p < 0.001; y = 0.87x + 0.03; standard error of estimate (SEE) = 0.125.)
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Figure 4 Difference in ROA estimation by 3D echo and proximal convergence plotted against mean ROA by the two techniques.
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