Three-dimensional Echocardiography in Mitral Valve Disease

Three-dimensional Echocardiography in Mitral Valve Disease

Kamp Otto
European Cardiology 2005
Published: May 2005
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Background
Echocardiography has evolved into the most predominant diagnostic imaging technique in cardiology. Over the last five decades the diagnostic capability of echocardiography has increased dramatically from M-mode to twodimensional (2-D) imaging. Recent advances in ultrasound instrumentation and computer technology have led to three-dimensional (3-D) echocardiography, introducing a new era in cardiovascular imaging.1 Every imaging technique in cardiology aims at a complete visualisation and comprehensive assessment of cardiac morphology and pathology, as the heart is a complex geometric structure. Analysis of the heart in motion in all three or four (including time) dimensions can therefore further facilitate and enhance the diagnostic capabilities of echocardiography. Three-dimensional echocardiography is still in its evolution and at the phase of early adaptation with respect to its clinical application. It should complement current echocardiographic techniques by providing better understanding of the topographical aspects of pathology and refined definition of the spatial relationships of (intra)cardiac structures. Furthermore, it provides new measures not described by 2-D echocardiography and makes the existing measures more accurate.2 The assessment of patients with mitral valve disease is one of the most challenging and promising clinical applications of 3-D echocardiography. The 3-D anatomy of the mitral valve, as well as the feasibility, accuracy and incremental value of 3-D echocardiography in the evaluation of mitral valve disease, will be discussed.

3-D Reconstruction
There are two main approaches of 3-D reconstruction. The first is random or freehand scanning, which is based on free motion of the ultrasound transducer. Its position in space is located by an acoustic, electromagnetic or mechanical arm location device. A transthoracic approach is used in this mode of acquisition. The limitation of this method is that accurate endocardial border identification is not possible because of big spaces between imaging planes. The second approach is sequential scanning, where the ultrasound motion is predetermined in linear, fan-like or rotational ways. A transthoracic or trans-oesophageal approach is used for this mode of data acquisition. Both the sequentially or randomly collected 2-D images are processed off-line by the computer using interpolation algorithms so that the gaps between individual images are filled and, finally, a volumetric 3-D data set is generated. There are several ways to present the data in the 3-D volumetric data set. The following are the most used.

Anyplane Echocardiography
This mode of presentation allows the examiner to generate 2-D tomographic images in any desired orientation that can be physically unobtainable by conventional 2-D echocardiography.

Volumetric Rendering Technique
This 3-D reconstruction creates images resembling the true anatomy of the heart. By choosing a cutting plane and reconstructing the image beyond this plane the heart can be opened as if by a surgeon. Different structures can be examined en face with increased perception of the anatomic relationships.

The ideal for 3-D reconstruction is realtime 3-D echocardiography (RT3D). The system uses a novel matrix phased-array transducer with parallel processing to scan a pyramidal volume. In a pyramidal volume, the images are displayed as anyplane or volume rendered images immediately. Second-generation matrix transducers recently became available for clinical studies.

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References:
  1. Lange A, Palka P, Burstow D J, Godman M J, “Three-dimensional echocardiography: Historical development and current applications”, J. Am. Soc. Echocardiogr. (2001);14: pp. 403–412.
  2. Hozumi T, Yoshikawa J, “Three-dimensional echocardiography using a multiplane transaesophageal probe: The clinical applications”, Echocardiography (2000);17: pp. 757–764.
  3. Bruining N, Lancée C H, Roelandt J R T C, Bom N, “Three-dimensional echocardiography paves the way toward virtual reality”, Ultrasound in Med. and Biol. (2000);26: pp. 1,065–1,074.
  4. Levine R A, Handschumacher M D, Sanfilippo A J, Hagege A A, Harrigan P, Marshall J E, Weyman A E, “Threedimensional echocardiographic reconstruction of the mitral valve, with implications for the diagnosis of mitral valve prolapse”, Circulation (1989);80: pp. 589–598.
  5. Flachskampf F A, Chandra S, Gaddipatti A, Levine R A, Weyman A E, Ameling W, Hanrath P, Thomas J, “Analysis of shape and motion of the mitral annulus in subjects with and without cardiomyopathy by echocardiographic 3-dimensional reconstruction”, J. Am. Soc. Echocardiogr. (2000);13: pp. 277–287.
  6. Kaplan S R, Bashein G, Sheehan F H et al., “Three-dimensional echocardiographic assessment of annular shape changes in the normal and regurgitant mitral valve”, Am. Heart J. (2000);139: pp. 378–387.
  7. Salgo I S, Gorman J H, Gorman R C et al., “Effect of annular shape on leaflet curvature in reducing mitral leaflet stress”, Circulation (2002);106: pp. 711–717.
  8. Rahimtoola S H, Durairaj A, Mehra A, Nuno I, “Current evaluation and management of patients with mitral stenosis”, Circulation (2002);106: pp. 1,183–1,188.
  9. Binder T, Rosenhek R, Porenta G, Maurer G, Baumgartner H, “Improved assessment of mitral valve stenosis by volumetric real-time three-dimensional echocardiography”, J. Am. Coll. Cardiol. (2000);36: pp. 1,355–1,361.
  10. Kupferwasser I, Mohr-Kahaly S, Menzel T et al., “Quantification of mitral valve stenosis by three-dimensional transaesophageal echocardiography”, Int. J. Card Imaging (1996);12: pp. 241–247.
  11. Chen Q, Nosir Y F M, Vletter W B, Kint P P, Salustri A, Roelandt J R T C, “Accurate mitral valve area assessment in patients with mitral stenosis by three-dimensional echocardiography”, J. Am. Soc. Echocardiogr. (1997);10: pp. 133–140.
  12. Kasliwal R, Trehan N, Mittal S, “A new ‘gold standard’ for the measurement of mitral valve area? Surgical validation of volume rendered three-dimensional echocardiography”, Circulation (1996);94(Suppl.): I–355 (abstract).
  13. Sugeng L, Weinert L, Lammertin G et al., “Accuracy of mitral valve area measurements using transthoracic rapid freehand 3-dimensional scanning: comparison with noninvasive and invasive methods”, J. Am. Soc. Echocardiogr. (2003);16: pp. 1,292–1,300.
  14. Limbu Y R, Shen X, Pan C, Shi Y, Chen H, “Assessment of mitral valve volume by quantitative three-dimensional echocardiography in patients with rheumatic mitral valve stenosis”, Clin. Cardiol. (1998);21: pp. 415–418.
  15. Gilon D, Cape E, Handschumacher M D et al., “Insights from three-dimensional echocardiographic laser stereolothography. Effect of leaflet funnel geometry on the coefficient of orifice contraction, pressure loss, and the Gorlin formula in mitral stenosis”, Circulation (1996);94: pp. 452–459.
  16. Applebaum R M, Kasliwal R R, Kanojia A et al., “Utility of three-dimensional echocardiography during balloon mitral valvuloplasty”, J. Am. Coll. Cardiol. (1998);32: pp. 1,405–1,409.
  17. Langerveld J, Valocik G, Plokker T et al., “Additional value of three-dimensional transaesophageal echocardiography for patients with mitral valve stenosis undergoing balloon valvuloplasty”, J. Am. Soc. Echocardiogr. (2003);16: pp. 841–849.
  18. Cheng T O, Wang X F, Zheng L H, Li Z A, Lu P, “Three-dimensional transaesophageal echocardiography in the diagnosis of mitral valve prolapse”, Am. Heart J. (1994);128: pp. 1,218–1,224.
  19. Cheng T O, Xie M X, Wang X F, Li Z A, Hu G, “Evaluation of mitral valve prolapse by four-dimensional echocardiography”, Am. Heart J. (1997);133: pp. 120–129.
  20. Ahmed S, Nanda N C, Miller A P et al., “Usefulness of transaesophageal three-dimensional echocardiography in the identification of individual segment/scallop prolapse of the mitral valve”, Echocardiography (2003);20: pp. 203–209.
  21. Chauvel C H, Bogino E, Clerc P, Fernandez G, Vernhet JCh, Becat A, Dehant P, “Usefulness of three-dimensional echocardiography for the evaluation of mitral valve prolapse: An intraoperative study”, J. Heart Valve Dis. (2000);9: pp. 341–349.
  22. Aikat S, Lewis J F, “Role of echocardiography in the diagnosis and prognosis of patients with mitral regurgitation”, Curr. Opin. Cardiol. (2003);18: pp. 334–339.
  23. Laskari C V, Masani N D, Pandian N G, “Three-dimensional echocardiography in mitral regurgitation”, Coron. Artery Dis. (1996);7: pp. 206–210.
  24. Irvine T, Li X N, Lennon D, Sahn D J, Kenny A, “Three dimensional colour Doppler echocardiography for the characterization and quantification of cardiac flow events”, Heart (2000);84 (Suppl II): ii2–ii6.
  25. Belohlavek M, Foley D A, Gerber T C, Greenleaf J F, Seward J B, “Three-dimensional reconstruction of color Doppler jets in the human heart”, J. Am. Soc. Echocardiogr. (1994);7: pp. 553–660.
  26. 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: pp. 1,103–1,106.
  27. Yao J, Masani N D, Cao Q L, Nikuta P, Pandian N G, “Clinical application of transthoracic volume-endered threedimensional echocardiography in the assessment of mitral regurgitation”, Am. J. Cardiol. (1998);82: pp. 189–196.
  28. De Simone R, Glombitza G, Vahl C H F, Meinzer H P, Hagl S, “Three-dimensional Doppler. Techniques and clinical applications”, Eur. Heart J. (1999);20: pp. 619–627.
  29. De Simone R, Glombitza G, Vahl C H F, Albers J, Meinzer H P, Hagl S, “Three-dimensional color Doppler: A clinical study in patients with mitral regurgitation”, J. Am. Coll. Cardiol. (1999);33: pp. 1,646–1,654.
  30. De Simone R, Glombitza G, Vahl C H F, Albers J, Meinzer H P, Hagl S, “Three-dimensional color Doppler for assessing mitral regurgitation during valvuloplasty”, Eur. J. Cardio-thorac Surg. (1999);15: pp. 127–133.
  31. De Simone R, Glombitza G, Vahl C H F, Albers J, Meinzer H P, Hagl S, “Three-dimensional color Doppler: A new approach for quantitative assessment of mitral regurgitant jets”, J. Am. Soc. Echocardiogr. (1999);12: pp. 173–185.
  32. De Simone R, Glombitza G, Vahl C F, Meinzer H P, Hagl S, “Three-dimensional color Doppler flow reconstruction and its clinical applications”, Echocardiography (2000);17: pp. 765–770.
  33. L Sugeng, Spencer K T, Mor-Avi V et al., “Dynamic three-dimensional color flow Doppler: An improved technique for the assessment of mitral regurgitation”, Echocardiography (2003);20: pp. 265–273.
  34. Li X, Shiota T, Delabays A, Teien D, Zhou X D, Sinclair B, Pandian N G, “Flow convergence flow rates 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: pp. 1,035–1,044.
  35. DeGroot C, Drangova M, Fenster A, Zhu S, Pflugfelder P W, Boughner D R, “Evaluation of 3-D colour Doppler ultrasound for the measurement of proximal isovelocity surface area”, Ultrasound Med. Biol. (2000);26: pp. 989–999.
  36. Sitges M, Jones M, Shiota T et al., “Real-time three-dimensional color Doppler evaluation of the flow convergence zone for quantification of mitral regurgitation: validation experimental study and initial clinical experience”, J. Am. Soc. Echocardiogr. (2002);16: pp. 38–45.
  37. Anayiotos A S, Smith B K, Kolda M, Fan P, Nanda N C, “Morphological evaluation of a regurgitant orifice by 3-D echocardiography: Applications in the quantification of valvular regurgitation”, Ultrasound Med. Biol. (1999);25: pp.
  38. Breburda C H S, Griffin B P, Pu M, Rodriguez L, Cosgrove D M, Thomas J D, “Three-dimensional echocardiographic planimetry of maximal regurgitant orifice area in myxomatous mitral regurgitation: intraoperative comparison with proximal flow convergence”, J. Am. Coll. Cardiol. (1998);32: pp. 432–437.
  39. Lange A, Palka P, Donnelly E, Burstow D J, “Quantification of mitral regurgitation orifice area by 3-dimensional echocardiography: comparison with effective regurgitant orifice area by PISA method and proximal regurgitant jet diameter”, Int. J. Cardiol. (2002);86: pp. 87–98.
  40. Kwan J, Shiota T, Agler D A et al., “Geometric differences of the mitral apparatus between ischemic and dilated cardiomyopathy with significant mitral regurgitation. Real-time three-dimensional echocardiography study”, Circulation (2002);107: pp. 1,135–1,140.
  41. Liel-Cohen N, Guerrero J L, Otsuji Y et al., “Design of a new surgical approach for ventricular remodeling to relieve ischemic mitral regurgitation. Insights from 3-dimensional echocardiography”, Circulation (2000);101: pp. 2,756–2,763.
  42. Otsuji Y, Handschumacher M D, Liel-Cohen N et al., “Mechanism of ischemic mitral regurgitation with segmental left ventricular dysfunction: Three-dimensional echocardiographic studies in models of acute and chronic progressive regurgitation”, J. Am. Coll. Cardiol. (2001);37: pp. 641–648.
  43. Messas E, Guerrero J L, Handschumacher M D, Chow C H M, Sullivan S, Schwammenthal E, Levine R A, “Paradoxic decrease in ischemic mitral regurgitation with papillary muscle dysfunction. Insights from three-dimensional and contrast echocardiography with strain rate measurement”, Circulation (2001);104: pp. 1,952–1,957.
  44. Tibayan F, Rodriguez F, Zasio M K et al., “Geometric distortions of the mitral valvular-ventricular complex in chronic ischemic mitral regurgitation”, Circulation (2003);108(Suppl II):II–116–II–121.
  45. DeAnda A Jr, Kasirajan V, Higgins R S D, “Mitral valve replacement versus repair in 2003: Where do we stand?”, Curr. Opin. Cardiol. (2003);18: pp. 102–105.
  46. Reul R, Cohn L, “Mitral valve reconstruction for mitral insufficiency”, Progr. Cardiovasc. Dis. (1997);39: pp. 567–599.
  47. Letsou G V, “Mitral valve repair and the anterior leaflet”, Curr. Opin. Cardiol. (2002);17: pp. 179–182.
  48. Qin J, Shiota T, McCarthy P M et al., “Importance of mitral valve repair associated with left ventricular reconstruction for patients with ischemic cardiomyopathy: A real-time three-dimensional echocardiographic study”, Circulation (2003);108(Suppl II):II–241–II–246.
  49. Abraham T, Warner J G, Kon N D et al., “Feasibility, accuracy, and incremental value of intraoperative three-dimensional transaesophageal echocardiography in valve surgery”, Am. J. Cardiol. (1997);80: pp. 1,577–1,582.

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