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The Role of 3-Dimensional Echocardiography in the Diagnosis and Management of Mitral Valve Disease. Cardiol Clin 2013; 31:203-15. [DOI: 10.1016/j.ccl.2013.03.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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de Agustín JA, Marcos-Alberca P, Fernandez-Golfin C, Gonçalves A, Feltes G, Nuñez-Gil IJ, Almeria C, Rodrigo JL, Perez de Isla L, Macaya C, Zamorano J. Direct Measurement of Proximal Isovelocity Surface Area by Single-Beat Three-Dimensional Color Doppler Echocardiography in Mitral Regurgitation: A Validation Study. J Am Soc Echocardiogr 2012; 25:815-23. [DOI: 10.1016/j.echo.2012.05.021] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Indexed: 11/30/2022]
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Muraru D, Badano LP, Vannan M, Iliceto S. Assessment of aortic valve complex by three-dimensional echocardiography: a framework for its effective application in clinical practice. ACTA ACUST UNITED AC 2012; 13:541-55. [DOI: 10.1093/ehjci/jes075] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Cobey FC, McInnis JA, Gelfand BJ, Rapo MA, D'Ambra MN. A method for automating 3-dimensional proximal isovelocity surface area measurement. J Cardiothorac Vasc Anesth 2012; 26:507-11. [PMID: 22325633 DOI: 10.1053/j.jvca.2011.12.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2011] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The proximal isovelocity surface area (PISA) is used for the echocardiographic quantification of effective orifice areas in valvular stenosis and regurgitation. Typically measured in 2 dimensions, the PISA relies on the geometric assumption that the shape of flow convergence is a hemisphere and that the orifice is a single circular point. Neither assumption is true. The objective was to develop a method for automating the measurement of the PISA in 3 dimensions and to illuminate the actual shape of the flow convergence pattern and how it changes over time. DESIGN Retrospective, single-case study. SETTING Major urban hospital. PARTICIPANTS This study was based on a single patient undergoing mitral valve replacement. INTERVENTIONS No additional interventions were performed in the patient. RESULTS The effective orifice areas calculated from the serial hemispheric, hemi-elliptic, and 3-dimensional (3D) PISAs during diastole were compared with the corresponding planimetric anatomic mitral orifice area. The effective orifice areas based on the manual and automated measurements of 3D PISAs more closely approximated the anatomic orifice than the effective orifice areas calculated using hemispheric or hemi-elliptic PISAs. CONCLUSIONS An automated analysis of 3D color Doppler data is feasible and allows a direct and accurate measurement of a 3D PISA, thus avoiding reliance on simplistic geometric assumptions. The dynamic aspect of cardiac orifices also must be considered in orifice analysis.
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Affiliation(s)
- Frederick C Cobey
- Department of Anesthesiology, Perioperative Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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Zhang L, Xie M, Balluz R, Ge S. Real Time Three-Dimensional Echocardiography for Evaluation of Congenital Heart Defects: State of the Art. Echocardiography 2012; 29:232-41. [DOI: 10.1111/j.1540-8175.2011.01589.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
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Three-dimensional echocardiography in paravalvular aortic regurgitation assessment after transcatheter aortic valve implantation. J Am Soc Echocardiogr 2011; 25:47-55. [PMID: 21962448 DOI: 10.1016/j.echo.2011.08.019] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Indexed: 12/17/2022]
Abstract
BACKGROUND Paravalvular aortic regurgitation (AR) after transcatheter aortic valve implantation (TAVI) is common, but the evaluation of its severity by two-dimensional (2D) transthoracic echocardiography (TTE) presents several constrains. The aim of this study was to assess the usefulness of a new methodology, using three-dimensional (3D) TTE, for better assessment of paravalvular AR after TAVI. METHODS Two-dimensional and 3D TTE was performed in 72 patients, 5 months after TAVI, using the X5-1 PureWave microbeamforming xMATRIX probe. The position and severity of the paravalvular AR jets were described using 2D and 3D TTE, and a model was designed for paravalvular AR systematic location description. Vena contracta width was measured using 2D transthoracic echocardiographic views, and the planimetry of the vena contracta was assessed after the perfect alignment plane was obtained using the multiplanar 3D transthoracic echocardiographic reconstruction tool. AR volume was calculated as the difference between 3D TTE-derived total left ventricular stroke volume and right ventricular stroke volume estimated using 2D TTE. Diagnostic efficiency for moderate AR was assessed using receiver operating characteristic curve analysis. RESULTS Forty-three patients (57.4%) presented with AR; 10 (13.3%) had central AR, and 33 (44.0%) had paravalvular AR jets. Vena contracta widths were similar between patients with moderate and mild AR (2.1 ± 0.53 vs 1.9 ± 0.16 mm, P = .16), but vena contracta planimetry was larger in patients with moderate AR than in those with mild AR (0.30 ± 0.12 vs 0.09 ± 0.07 cm(2), P = .001). Vena contracta planimetry on 3D TTE was better correlated with AR volume than vena contracta width on 2D TTE (Kendall's τ = 0.82 [P < .001] vs 0.66 [P < .001]). The areas under the receiver operating characteristic curves were 0.96 for vena contracta planimetry and 0.35 for vena contracta width. CONCLUSIONS This study proposes an alternative methodology for paravalvular AR assessment after TAVI. Using vena contracta planimetry on 3D TTE, an accurate methodology for paravalvular AR jet evaluation and moderate AR classification is described.
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Direct measurement of proximal isovelocity surface area by real-time three-dimensional color Doppler for quantitation of aortic regurgitant volume: an in vitro validation. J Am Soc Echocardiogr 2009; 22:306-13. [PMID: 19168322 DOI: 10.1016/j.echo.2008.11.031] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2008] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The proximal isovelocity surface area (PISA) method is useful in the quantitation of aortic regurgitation (AR). We hypothesized that actual measurement of PISA provided with real-time 3-dimensional (3D) color Doppler yields more accurate regurgitant volumes than those estimated by 2-dimensional (2D) color Doppler PISA. METHODS We developed a pulsatile flow model for AR with an imaging chamber in which interchangeable regurgitant orifices with defined shapes and areas were incorporated. An ultrasonic flow meter was used to calculate the reference regurgitant volumes. A total of 29 different flow conditions for 5 orifices with different shapes were tested at a rate of 72 beats/min. 2D PISA was calculated as 2pi r(2), and 3D PISA was measured from 8 equidistant radial planes of the 3D PISA. Regurgitant volume was derived as PISA x aliasing velocity x time velocity integral of AR/peak AR velocity. RESULTS Regurgitant volumes by flow meter ranged between 12.6 and 30.6 mL/beat (mean 21.4 +/- 5.5 mL/beat). Regurgitant volumes estimated by 2D PISA correlated well with volumes measured by flow meter (r = 0.69); however, a significant underestimation was observed (y = 0.5x + 0.6). Correlation with flow meter volumes was stronger for 3D PISA-derived regurgitant volumes (r = 0.83); significantly less underestimation of regurgitant volumes was seen, with a regression line close to identity (y = 0.9x + 3.9). CONCLUSION Direct measurement of PISA is feasible, without geometric assumptions, using real-time 3D color Doppler. Calculation of aortic regurgitant volumes with 3D color Doppler using this methodology is more accurate than conventional 2D method with hemispheric PISA assumption.
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Abstract
Three-dimensional (3D) color Doppler echocardiography is a relatively new noninvasive tool that displays and quantitates regurgitant flow and also enables estimation of cardiac output, stroke volume, pulmonary outflow, and shunt calculations. This article provides an overview of the current methodology of 3D color flow, and its advantages and limitations.
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Affiliation(s)
- Lissa Sugeng
- Section of Cardiology, Department of Medicine, University of Chicago Medical Center, MC 5084, 5841 South Maryland Avenue, Chicago, IL 60637, USA.
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Iwakura K, Ito H, Kawano S, Okamura A, Kurotobi T, Date M, Inoue K, Fujii K. Comparison of orifice area by transthoracic three-dimensional Doppler echocardiography versus proximal isovelocity surface area (PISA) method for assessment of mitral regurgitation. Am J Cardiol 2006; 97:1630-7. [PMID: 16728228 DOI: 10.1016/j.amjcard.2005.12.065] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2005] [Revised: 12/06/2005] [Accepted: 12/06/2005] [Indexed: 11/29/2022]
Abstract
Effective regurgitant orifice area is a useful index of the severity of mitral regurgitation (MR). The calculation of regurgitant orifice area using the proximal isovelocity surface area (PISA) method has some technical limitations. Three-dimensional reconstruction of the MR jet was performed using the Live 3D system on a Sonos 7500 to measure regurgitant orifice area directly in 109 cases of MR. Regurgitant orifice area was also measured by quantitative 2-dimensional echocardiography and by the PISA method. To analyze the shape of the regurgitant orifice, the ratio of the long axis to the short axis of the orifice (the L/S ratio) was calculated. Regurgitant orifice area on 3-dimensional echocardiography showed an almost identical correlation with that obtained by quantitative echocardiography (r = 0.91, p <0.0001, slope = 0.97) regardless of the L/S ratio. It was also significantly correlated with orifice area obtained using the PISA method (r = 0.93, p <0.0001). However, orifice area on 3-dimensional echocardiography was significantly larger than that obtained using the PISA method in the whole study group and in the 62 cases of MR with L/S ratios >1.5, whereas the correlation was almost identical in cases of MR with L/S ratios < or =1.5. Orifice area obtained using the PISA method also underestimated that obtained by quantitative echocardiography in cases of MR with L/S ratios >1.5. Three-dimensional echocardiography provided robust values independent of the eccentricity of the MR jet or of cardiac rhythm. In conclusion, the direct measurement of the regurgitant orifice area of MR with 3-dimensional Doppler echocardiography could be a promising method to overcome the limitations of the PISA method, especially in cases of MR with elliptic orifice shapes.
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Affiliation(s)
- Katsuomi Iwakura
- Division of Cardiology, Sakurabashi Watanabe Hospital, Osaka, Japan.
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Fang L, Hsiung MC, Miller AP, Nanda NC, Yin WH, Young MS, Velayudhan DE, Rajdev S, Patel V. Assessment of Aortic Regurgitation by Live Three-Dimensional Transthoracic Echocardiographic Measurements of Vena Contracta Area: Usefulness and Validation. Echocardiography 2005; 22:775-81. [PMID: 16194172 DOI: 10.1111/j.1540-8175.2005.00171.x] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
In this report, we evaluate 56 consecutive adult patients who underwent standard two-dimensional (2D) and live three-dimensional transthoracic echocardiography (3D TTE), as well as left heart catheterization with aortography (45 patients) or cardiac surgery (11 patients), for evaluation of aortic insufficiency. Similar to the method we previously described for mitral insufficiency, aortic regurgitant vena contracta area (VCA) was obtained by 3D TTE by systematic and sequential cropping of the acquired 3D TTE data set. Assessments of aortic regurgitation (AR) by aortography and surgery are compared to measurements of VCA by 3D TTE and to 2D TTE measurements of vena contracta width (VCW). Aortographic or surgical grading correlated well with 2D TTE measurements of VCW (r = 0.92), but correlated better with 3D TTE measurements of VCA (r = 0.95), with improved dispersion between angiographic grades demonstrated by the 3D TTE technique. Live 3D TTE color Doppler measurements of VCA can be used for accurate assessment of AR and are comparable to assessment by aortography.
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Affiliation(s)
- Ligang Fang
- Division of Cardiovascular Diseases, University of Alabama at Birmingham, Birmingham, Alabama 35249, USA
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Li X, Jones M, Irvine T, Rusk RA, Mori Y, Hashimoto I, Von Ramm OT, Li J, Zetts A, Pemberton J, Sahn DJ. Real-time 3-dimensional echocardiography for quantification of the difference in left ventricular versus right ventricular stroke volume in a chronic animal model study: Improved results using C-scans for quantifying aortic regurgitation. J Am Soc Echocardiogr 2004; 17:870-5. [PMID: 15282492 DOI: 10.1016/j.echo.2004.04.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The purpose of our study was to test the applicability of calculating the difference between left ventricular (LV) and right ventricular (RV) stroke volume (SV) for assessing the severity of aortic (Ao) regurgitation (AR) using a real-time 3-dimensional (3D) echocardiographic (RT3DE) imaging system. METHODS The Ao valve was incised in 5 juvenile sheep, 6 to 10 weeks before the study, to produce AR (mean regurgitant fraction = 0.50). Simultaneous hemodynamic and RT3DE images were obtained on open-chest animals with Ao and pulmonary flows derived by Ao and pulmonary electromagnetic flowmeters balanced against each other. Four stages (baseline, volume loading, sodium nitroprusside, and angiotensin infusion) were used to produce a total of 16 different hemodynamic states. Epicardial scanning was done with a 2.5-MHz probe to sequentially record first the RV and then the LV cavities. Cavity volumes from the 3D echocardiography data were determined from angled sector planes (B-scans) and parallel cutting planes (C-scans, which are planes perpendicular to the direction of the volume interrogation). AR volumes were determined from 3D images by computing and then subtracting RV SVs from LV SVs and then these were compared with electromagnetic flowmeter-derived SV and regurgitant volumes. RESULTS There was close correlation between RV and LV SVs of the RT3DE and electromagnetic methods (C-scans: LV, r = 0.98, standard error of the estimate [SEE] = 2.62 mL, P =.0001; RV, r = 0.89, SEE = 2.67 mL, P <.0001; and B-scans: LV, r = 0.95, SEE = 3.55 mL, P =.0001; RV, r = 0.77, SEE = 2.78 mL, P =.0003). Because of the small size of the RV in this model, the correlation was closer for C-scans than B-scans for RV SV. AR volume estimation also showed that C-scan (r = 0.93, SEE = 4.23 mL, P <.0001) had closer correlation than B-scan (r = 0.89, SEE = 4.87 mL, P <.0001). However, B-scan-derived AR fraction showed closer correlation than did C-scan (r = 0.82 vs r = 0.85, respectively). CONCLUSION In this animal model, RT3DE imaging had the ability to reliably quantify both LV (B- and C-scans) and RV SVs and to assess the severity of AR.
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Affiliation(s)
- Xiaokui Li
- Clinical Care Center for Congenital Heart Disease, Oregon Health and Science University, Portland, OR 97239, USA
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Sitges M, Jones M, Shiota T, Qin JX, Tsujino H, Bauer F, Kim YJ, Agler DA, Cardon LA, Zetts AD, Panza JA, Thomas JD. Real-time three-dimensional color doppler evaluation of the flow convergence zone for quantification of mitral regurgitation: Validation experimental animal study and initial clinical experience. J Am Soc Echocardiogr 2003; 16:38-45. [PMID: 12514633 DOI: 10.1067/mje.2003.37] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Pitfalls of the flow convergence (FC) method, including 2-dimensional imaging of the 3-dimensional (3D) geometry of the FC surface, can lead to erroneous quantification of mitral regurgitation (MR). This limitation may be mitigated by the use of real-time 3D color Doppler echocardiography (CE). Our objective was to validate a real-time 3D navigation method for MR quantification. METHODS In 12 sheep with surgically induced chronic MR, 37 different hemodynamic conditions were studied with real-time 3DCE. Using real-time 3D navigation, the radius of the largest hemispherical FC zone was located and measured. MR volume was quantified according to the FC method after observing the shape of FC in 3D space. Aortic and mitral electromagnetic flow probes and meters were balanced against each other to determine reference MR volume. As an initial clinical application study, 22 patients with chronic MR were also studied with this real-time 3DCE-FC method. Left ventricular (LV) outflow tract automated cardiac flow measurement (Toshiba Corp, Tokyo, Japan) and real-time 3D LV stroke volume were used to quantify the reference MR volume (MR volume = 3DLV stroke volume - automated cardiac flow measurement). RESULTS In the sheep model, a good correlation and agreement was seen between MR volume by real-time 3DCE and electromagnetic (y = 0.77x + 1.48, r = 0.87, P <.001, delta = -0.91 +/- 2.65 mL). In patients, real-time 3DCE-derived MR volume also showed a good correlation and agreement with the reference method (y = 0.89x - 0.38, r = 0.93, P <.001, delta = -4.8 +/- 7.6 mL). CONCLUSIONS real-time 3DCE can capture the entire FC image, permitting geometrical recognition of the FC zone geometry and reliable MR quantification.
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Affiliation(s)
- Marta Sitges
- Cardiovascular Imaging Center, Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
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Affiliation(s)
- T Irvine
- Cardiothoracic Unit, Freeman Hospital, Newcastle upon Tyne, UK
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Li X, Wanitkun S, Li XN, Hashimoto I, Mori Y, Rusk RA, Hicks SE, Sahn DJ. Quantification of instantaneous flow rate and dynamically changing effective orifice area using a geometry independent three-dimensional digital color Doppler method: An in vitro study mimicking mitral regurgitation. J Am Soc Echocardiogr 2002; 15:1189-96. [PMID: 12411904 DOI: 10.1067/mje.2002.124515] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Our study was intended to test the accuracy of a 3-dimensional (3D) digital color Doppler flow convergence (FC) method for assessing the effective orifice area (EOA) in a new dynamic orifice model mimicking a variety of mitral regurgitation. BACKGROUND FC surface area methods for detecting EOA have been reported to be useful for quantifying the severity of valvular regurgitation. With our new 3D digital direct FC method, all raw velocity data are available and variable Nyquist limits can be selected for computation of direct FC surface area for computing instantaneous flow rate and temporal change of EOA. METHODS A 7.0-MHz multiplane transesophageal probe from an ultrasound system (ATL HDI 5000) was linked and controlled by a computer workstation to provide 3D images. Three differently shaped latex orifices (zigzag, arc, and straight slit, each with cutting-edge length of 1 cm) were used to mimic the dynamic orifice of mitral regurgitation. 3D FC surface computation was performed on parallel slices through the 3D data set at aliasing velocities (14-48 cm/s) selected to maximize the regularity and minimize lateral dropout of the visualized 3D FC at 5 points per cardiac cycle. Using continuous wave velocity for each, 3D-calculated EOA was compared with EOA determined by using continuous wave Doppler and the flow rate from a reference ultrasonic flow meter. Simultaneous digital video images were also recorded to define the actual orifice size for 9 stroke volumes (15-55 mL/beat with maximum flow rates 45-182 mL/s). RESULTS Over the 9 pulsatile flow states and 3 orifices, 3D FC EOAs (0.05-0.63 cm(2)) from different phases of the cardiac cycle in each pump setting correlated well with reference EOA (r = 0.89-0.92, SEE = 0.027-0.055cm(2)) and they also correlated well with digital video images of the actual orifice peak (r = 0.97-0.98, SEE = 0.016-0.019 cm(2)), although they were consistently smaller, as expected by the contraction coefficient. CONCLUSION The digital 3D FC method can accurately predict flow rate, and, thus, EOA (in conjunction with continuous wave Doppler), because it allows direct FC surface measurement despite temporal variability of FC shape.
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Affiliation(s)
- Xiaokui Li
- Clinical Care Center for Congenital Heart Disease, Portland, Oregon 97201, USA
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Irvine T, Stetten GD, Sachdev V, Zetts AD, Jones M, Mori Y, Ramsperger C, Castellucci JB, Kenny A, Panza JA, von Ramm OT, Sahn DJ. Quantification of aortic regurgitation by real-time 3-dimensional echocardiography in a chronic animal model: computation of aortic regurgitant volume as the difference between left and right ventricular stroke volumes. J Am Soc Echocardiogr 2001; 14:1112-8. [PMID: 11696837 DOI: 10.1067/mje.2001.115660] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND The accuracy of conventional 2-dimensional echocardiographic and Doppler techniques for the quantification of valvular regurgitation remains controversial. In this study, we examined the ability of real-time 3-dimensional (RT3D) echocardiography to quantify aortic regurgitation by computing aortic regurgitant volume as the difference between 3D echocardiographic-determined left and right ventricular stroke volumes in a chronic animal model. METHODS Three to 6 months before the study, 6 sheep underwent surgical incision of one aortic valve cusp to create aortic regurgitation. During the subsequent open chest study session, a total of 25 different steady-state hemodynamic conditions were examined. Electromagnetic (EM) flow probes were placed around the main pulmonary artery and ascending aorta and balanced against each other to provide reference right and left ventricular stroke volume (RVSV and LVSV) data. RT3D imaging was performed by epicardial placement of a matrix array transducer on the volumetric ultrasound system, originally developed at the Duke University Center for Emerging Cardiovascular Technology. During each hemodynamic steady state, the left and right ventricles were scanned in rapid succession and digitized image loops stored for subsequent measurement of end-diastolic and end-systolic volumes. Left and right ventricular stroke volumes and aortic regurgitant volumes were then calculated and compared with reference EM-derived values. RESULTS There was good correlation between RT3D left and right ventricular stroke volumes and reference data (r = 0.83, y = 0.94x + 2.6, SEE = 9.86 mL and r = 0.63, y = 0.8x - 1.0, SEE = 5.37 mL, respectively). The resulting correlation between 3D- and EM-derived aortic regurgitant volumes was at an intermediate level between that for LVSV and that for RVSV (r = 0.80, y = 0.88x + 7.9, SEE = 10.48 mL). RT3D tended to underestimate RVSV (mean difference -4.7 +/- 5.4 mL per beat, compared with -0.03 +/- 9.7 mL per beat for the left ventricle). There was therefore a small overestimation of aortic regurgitant volume (4.7 +/- 10.4 mL per beat). CONCLUSION Quantification of aortic regurgitation through the computation of ventricular stroke volumes by RT3D is feasible and shows good correlation with reference flow data. This method should also be applicable to the quantification of other valvular lesions or single site intracardiac shunts where a difference between right and left ventricular cavity stroke volumes is produced.
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Affiliation(s)
- T Irvine
- Pediatric Cardiology, Oregon Health Sciences University, 3181 SW Sam Jackson Park Road, Portland, OR 97201-3098, USA
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Lange A, Palka P, Burstow DJ, Godman MJ. Three-dimensional echocardiography: historical development and current applications. J Am Soc Echocardiogr 2001; 14:403-12. [PMID: 11337688 DOI: 10.1067/mje.2001.113147] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Three-dimensional (3D) echocardiography facilitates spatial recognition of intracardiac structures, potentially enhancing diagnostic confidence of conventional echocardiography. The accuracy of 3D images has been validated in vitro and in vivo. In vitro, a detail 1.0 mm in dimension and 2 details separated by 1.0 mm can be identified from a volume-rendered 3D image. In vitro 3D volume measurements are underestimated by approximately 4.0 mL. In vivo, left ventricular volume measurements correlate highly with both cineventriculography (limits of agreement +/-18 mL for end diastole and +/-10 mL for end systole) and magnetic resonance imaging, including measurements for patients with functionally single ventricles. Studies on congenital heart lesions have shown good accuracy and good reproducibility of dynamic "surgical" reconstructions of septal defects, aortoseptal continuity, atrioventricular junction, and both left and right ventricular outflow tract morphology. Transthoracic 3D echocardiography was shown feasible in 81% to 96% of patients with congenital heart defects and provided additional information to that available from conventional echocardiography in 36% of patients, mainly in more detailed description of mitral valve morphology, aortoseptal continuity, and atrial septum. In patients with mitral valve insufficiency, 3D echocardiography was shown to be accurate in the quantification of the dynamic mechanism of mitral regurgitation and in the assessment of mitral commissures in patients with mitral stenosis. This includes not only valve tissue reconstruction but also color flow intracardiac jets. Three-dimensional reconstructions of the aortic valve were achieved in 77% of patients, with an accuracy of 90%. In conclusion, the role of 3D echocardiography, which continues to evolve, shows promise in the assessment of congenital and acquired heart disease.
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Affiliation(s)
- A Lange
- Department of Cardiology, The Prince Charles Hospital, Chermside, Brisbane, Australia.
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Tsujino H, Jones M, Shiota T, Qin JX, Greenberg NL, Cardon LA, Morehead AJ, Zetts AD, Travaglini A, Bauer F, Panza JA, Thomas JD. Real-time three-dimensional color Doppler echocardiography for characterizing the spatial velocity distribution and quantifying the peak flow rate in the left ventricular outflow tract. ULTRASOUND IN MEDICINE & BIOLOGY 2001; 27:69-74. [PMID: 11295272 DOI: 10.1016/s0301-5629(00)00270-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Quantification of flow with pulsed-wave Doppler assumes a "flat" velocity profile in the left ventricular outflow tract (LVOT), which observation refutes. Recent development of real-time, three-dimensional (3-D) color Doppler allows one to obtain an entire cross-sectional velocity distribution of the LVOT, which is not possible using conventional 2-D echo. In an animal experiment, the cross-sectional color Doppler images of the LVOT at peak systole were derived and digitally transferred to a computer to visualize and quantify spatial velocity distributions and peak flow rates. Markedly skewed profiles, with higher velocities toward the septum, were consistently observed. Reference peak flow rates by electromagnetic flow meter correlated well with 3-D peak flow rates (r = 0.94), but with an anticipated underestimation. Real-time 3-D color Doppler echocardiography was capable of determining cross-sectional velocity distributions and peak flow rates, demonstrating the utility of this new method for better understanding and quantifying blood flow phenomena.
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Affiliation(s)
- H Tsujino
- Cardiovascular Imaging Center, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA
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Irvine T, Li XN, Rusk R, Lennon D, Sahn DJ, Kenny A. Three dimensional colour Doppler echocardiography for the characterisation and quantification of cardiac flow events. Heart 2000; 84 Suppl 2:II2-6. [PMID: 11040028 PMCID: PMC1766541 DOI: 10.1136/heart.84.suppl_2.ii2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- T Irvine
- Cardiothoracic Unit, Freeman Hospital, Newcastle upon Tyne, UK
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deGroot C, Drangova M, Fenster A, Zhu S, Pflugfelder PW, Boughner DR. Evaluation of 3-D colour Doppler ultrasound for the measurement of proximal isovelocity surface area. ULTRASOUND IN MEDICINE & BIOLOGY 2000; 26:989-999. [PMID: 10996699 DOI: 10.1016/s0301-5629(00)00245-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Three-dimensional (3-D) colour Doppler ultrasound (US) enables flow rate estimation across a diseased valve without the need for a priori geometric assumptions. This study quantitatively evaluates the accuracy of 3-D colour Doppler US for measuring the flow rate (8. 3-75 mL/s) through a valve using the proximal flow convergence field. Flow rate measurements by this 3-D technique underestimate flow through finite circular orifices due to two major sources of error: 1. surface area slicing technique (18.3% +/- 3.8%) and 2. Doppler angle effect (41.0% +/- 1.5%). Combined total underestimation is 51% +/- 3.3%. To utilize 3-D US, the development of an improved proximal isovelocity surface area (PISA) measurement technique and a correction factor for the Doppler angle effect is required.
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Affiliation(s)
- C deGroot
- John P. Robarts Research Institute, London, Ontario, Canada
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22
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Abstract
Quantification of aortic regurgitation (AR) is a common and difficult clinical problem. The severity of regurgitation has traditionally been estimated with the use of contrast aortography, which is impractical as a screening tool or for serial examinations. In the past two decades, Doppler echocardiography has emerged as an important tool in the quantification of AR. Pulsed Doppler mapping of the depth of the regurgitant jet into the left ventricle was one of the initial echocardiographic methods used for this purpose. The slope and pressure (or velocity) half-time of continuous-wave Doppler profiles of regurgitant jets are also useful. These Doppler techniques may be used to determine the regurgitant volume or regurgitant fraction in patients with AR. The use of color Doppler to measure the height (or cross-sectional area) of the regurgitant jet relative to the height (cross-sectional area) of the left ventricular outflow tract is both sensitive and specific in the quantification of AR. More recently, the continuity principle has been used to determine the effective aortic regurgitant orifice area, which increases as AR becomes more severe. Although this is a promising tool, calculation of this value is not yet common practice in most echocardiography laboratories. Although no single echocardiographic technique is without limitations, all have some validity, and it is reasonable to use a combination of them to obtain a composite estimate of the severity of AR.
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Affiliation(s)
- D L Ekery
- Section of Cardiology, Boston University Medical Center, 88 East Newton Street, Boston, MA 02118, USA
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Li X, Shiota T, Delabays A, Teien D, Zhou X, Sinclair B, Pandian NG, Sahn DJ. Flow convergence flow rates from 3-dimensional reconstruction of color Doppler flow maps for computing transvalvular regurgitant flows without geometric assumptions: An in vitro quantitative flow study. J Am Soc Echocardiogr 1999; 12:1035-44. [PMID: 10588778 DOI: 10.1016/s0894-7317(99)70099-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE This study was designed to develop and test a 3-dimensional method for direct measurement of flow convergence (FC) region surface area and for quantitating regurgitant flows with an in vitro flow system. BACKGROUND Quantitative methods for characterizing regurgitant flow events such as flow convergence with 2-dimensional color flow Doppler imaging systems have yielded variable results and may not be accurate enough to characterize those more complex spatial events. METHOD Four differently shaped regurgitant orifices were studied: 3 flat orifices (circular, rectangular, triangular) and a nonflat one mimicking mitral valve prolapse (all 4 orifice areas = 0.24 cm(2)) in a pulsatile flow model at 8 to 9 different regurgitant flow rates (10 to 50 mL/beat). An ultrasonic flow probe and meter were connected to the flow model to provide reference flow data. Video composite data from the color Doppler flow images of the FC were reconstructed after computer-controlled 180 degrees rotational acquisition was performed. FC surface area (S cm(2)) was calculated directly without any geometric assumptions by measuring parallel sliced flow convergence arc lengths through the FC volume and multiplying each by the slice thickness (2.5 to 3.2 mm) over 5 to 8 slices and then adding them together. Peak regurgitant flow rate (milliliters per second) was calculated as the product of 3-dimensional determined S (cm(2)) multiplied by the aliasing velocity (centimeters per second) used for color Doppler imaging. RESULTS For all of the 4 shaped orifices, there was an excellent relationship between actual peak flow rates and 3-dimensional FC-calculated flow rates with the direct measurement of the surface area of FC (r = 0.99, mean difference = -7.2 to -0.81 mL/s, % difference = -5% to 0%), whereas a hemielliptic method implemented with 3 axial measurements of the flow convergence zone from 2-dimensional planes underestimated actual flow rate by mean difference = -39.8 to -18.2 mL/s, % difference = -32% to -17% for any given orifice. CONCLUSIONS Three-dimensional reconstruction of flow based on 2-dimensional color Doppler may add quantitative spatial information, especially for complex flow events. Direct measurement of 3-dimensional flow convergence surface areas may improve accuracy for estimation of the severity of valvular regurgitation.
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Affiliation(s)
- X Li
- Clinical Care Center for Congenital Heart Disease, Oregon Health Sciences University, Portland, OR 97201, USA
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Irvine T, Derrick G, Morris D, Norton M, Kenny A. Three-dimensional echocardiographic reconstruction of mitral valve color Doppler flow events. Am J Cardiol 1999; 84:1103-6, A10. [PMID: 10569677 DOI: 10.1016/s0002-9149(99)00512-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In vitro studies have suggested superior accuracy of 3-dimensional echocardiography over conventional methods for the characterization and quantitation of color Doppler flow events. Little in vivo work has been reported in this area; this study demonstrates the feasibility of 3-dimensional reconstruction of mitral valve flow events in an unselected group of adult patients and discusses optimal instrument settings for the acquisition of 3-dimensional datasets.
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Affiliation(s)
- T Irvine
- Department of Echocardiography, Regional Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne, Tyne and Wear, United Kingdom
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Shiota T, McCarthy PM, White RD, Qin JX, Greenberg NL, Flamm SD, Wong J, Thomas JD. Initial clinical experience of real-time three-dimensional echocardiography in patients with ischemic and idiopathic dilated cardiomyopathy. Am J Cardiol 1999; 84:1068-73. [PMID: 10569665 DOI: 10.1016/s0002-9149(99)00500-7] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The geometry of the left ventricle in patients with cardiomyopathy is often sub-optimal for 2-dimensional ultrasound when assessing left ventricular (LV) function and localized abnormalities such as a ventricular aneurysm. The aim of this study was to report the initial experience of real-time 3-D echocardiography for evaluating patients with cardiomyopathy. A total of 34 patients were evaluated with the real-time 3D method in the operating room (n = 15) and in the echocardiographic laboratory (n = 19). Thirteen of 28 patients with cardiomyopathy and 6 other subjects with normal LV function were evaluated by both real-time 3-D echocardiography and magnetic resonance imaging (MRI) for obtaining LV volumes and ejection fractions for comparison. There were close relations and agreements for LV volumes (r = 0.98, p <0.0001, mean difference = -15 +/- 81 ml) and ejection fractions (r = 0.97, p <0.0001, mean difference = 0.001 +/- 0.04) between the real-time 3D method and MRI when 3 cardiomyopathy cases with marked LV dilatation (LV end-diastolic volume >450 ml by MRI) were excluded. In these 3 patients, 3D echocardiography significantly underestimated the LV volumes due to difficulties with imaging the entire LV in a 60 degrees x 60 degrees pyramidal volume. The new real-time 3D echocardiography is feasible in patients with cardiomyopathy and may provide a faster and lower cost alternative to MRI for evaluating cardiac function in patients.
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Affiliation(s)
- T Shiota
- Department of Cardiology, Kaufman Center for Heart Failure, The Cleveland Clinic Foundation, Ohio, USA.
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