Improved assessment of mitral valve stenosis by volumetric real-time three-dimensional echocardiography
Thomas M. Binder, MDa,b,
Raphael Rosenhek, MDa,b,
Gerold Porenta, MD, PhDa,b,
Gerald Maurer, MD, FACCa,b and
Helmut Baumgartner, MD, FACCa,b
a Department of Cardiology, University of Vienna, Austria
b Ludwig Boltzmann Institute, Austria
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Figure 1 Real-time volumetric scanning: Images are displayed as two steerable perpendicular conventional B-mode image sectors. "C planes" that transect the scan plane were used to obtain short axis views of the mitral valve from the apical window.
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Figure 2 Short-axis view of the mitral valve depicting the mitral valve area (MVA) in the same patient by 2-D echo and 3-D echo.
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Figure 3 Morphologic types of mitral stenosis that were used to examine the influence of image plane variations on MVA measurements. (A) Prominent doming of the mitral valve (type I), (B) funnel shape of the stenosis (type II).
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Figure 4 Schematic drawing of a stenotic mitral valve and the image planes that were used to study the effects of image plane variations on mitral valve areas. The optimal C plane (A) through the mitral valve orifice was defined. Using this plane, x- and y-axis were varied in 3° increments over a range of –6° to +6° to create 24 image planes from which MVA were calculated. This procedure was repeated for image planes separated by 1 mm (B) and 2 mm (C) from the optimal image plane.
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Figure 5 Correlation (A) and Bland-Altman plot (B)comparing measurements of MVA obtained by 2-D echo and 3-D echo.
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Figure 6 Interobserver variability: regression analysis (left) and corresponding Bland-Altman plots (right) for 2-D echo (top panel) and 3-D echo (bottom panel).
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