Three-dimensional color doppler: a clinical study in patients with mitral regurgitation
Raffaele De Simone, MD*,
Gerald Glombitza, PhD ,
Christian Friedrich Vahl, MD*,
J.örg Albers, MD*,
Hans Peter Meinzer, PhD and
Siegfried Hagl, MD*
* University of Heidelberg, Heidelberg, Germany
Deutsches Krebsforschungszentrum, Heidelberg, Germany
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Figure 1 Central jet in a patient with a moderate-to-severe mitral regurgitation. The origin of the regurgitant jet can be visualized in different views from 60° to 150° (arrows). The empty arrows in the three-dimensional reconstruction show the extension of the regurgitant orifice, which consists of a large linear coaptation defect of the commissures. The arrowheads show a small, additional jet, the origin of which (empty arrowheads) can be observed in the multiplanar examination at 90°. The volume of the regurgitant jet is consistent with a large mitral regurgitation. LA = left atrium; LV = left ventricle. * = left ventricular outflow tract.
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Figure 2 Mitral valve regurgitation in a patient with posterior mitral valve prolapse. The prolapse of the posterior leaflet can be observed at the multiplanar examinations from 0° to 180° (arrows). The regurgitant jet is directed along the atrial surface of the anterior leaflet and has a "tongue" pattern. The main direction of the regurgitant flow can be visualized at about 120°. The proximal isovelocity region of the jet (empty arrow) appears very irregular. LA = left atrium; LV = left ventricle. * = left ventricular outflow tract.
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Figure 3 Mitral regurgitant jet with a "spiral" pattern in a patient with anterior prolapse. This jet is directed perpendicular to the mitral annulus, then it turns twice in direction (arrows), according to the curvature of the left atrial wall. The transverse section of the jet proximal to its origin has a circular shape. The arrowheads in the three-dimensional image at 60° show the reverse systolic flow in the left upper and lower pulmonary veins. Due to the particular direction of the regurgitant jet, the detection of reverse systolic pulmonary flow by pulsed Doppler does not indicate a severe degree of mitral regurgitation. LA = left atrium; LV = left ventricle.
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Figure 4 Anterior mitral valve prolapse. The shape of the regurgitant jet has a "spoon" pattern. The origin of this jet has a wide and short initial portion, first directed along the atrial surface of the posterior mitral leaflet and then against the atrial wall (arrows). The extent of its lateral spreading cannot be visualized by conventional color Doppler. The two-dimensional view at 60° can only visualize the initial portion of the jet at its origin (empty arrow). The convex face of this jet can be observed at three-dimensional Doppler from 0° to 120°, the concave face (dashed line) at 180°. The prolapse of the anterior mitral leaflet can be observed in the multiplanar view at 30° and 60°. AO = aortic valve; LA = left atrium; LV = left ventricle.
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Figure 5 Mitral regurgitant jet with a "spoon" pattern in a patient with anterior prolapse. The pattern of this jet is similar to that in Figure 4. The two-dimensional view at 60° can only visualize the initial portion of the jet at its origin. The two objects to the right show surface three-dimensional reconstructions of the jet viewed from the corresponding view angles (60° and 150°). LA = left atrium; LV = left ventricle.
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Figure 6 (A, B): Regression analysis of jet areas (A) and jet volumes (B) versus regurgitation volumes in 28 patients with central jets. (C, D): Regression analysis of jet areas (C) and jet volumes (D) versus regurgitation volumes in 30 patients with eccentric jets. SEE = standard error of estimate.
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