Assessing AV valve regurgitation: MR
Real Time Three-Dimensional Color Doppler Echocardiographic Characterization of Regurgitant Orifice Area in Children with Mitral Regurgitation.
We use colour 3D MPR to define the effective regurgitant orifice area in quantifying mitral regurgitation in children, and to derive indices for assessing mitral regurgitation
All patients referred for evaluation of MR
had Standard 2-D assessment
from the routine clinics. No sedation and images acquired like any transthoracic echo
Age/height/weight, clinical symptoms recorded.
Images were acquired using Phillips Sonos 7500/ IE33 using
4 MHz X4 transducer/ X3-1 transducer.
Full volume dataset of mitral valve
and Full volume colour Doppler data set - MR
Analysis performed with Q lab version-4.1
Severity of clinical symptoms were scored 1-3. 2-D echocardiographic findings were sored mild, moderate or severe (1-3) Pulmonary venous hypertension was scored from (1-3) using CXR by an experienced cardiac radiologist blinded to the clinical or echocardiographic findings.
Total clinical score was tabulated as
Mild- 0-3, Moderate- 4-6,
Severe > 7
Fig 1: Alignment of MPR planes along the regurgitant jet to obtain vena contracta area
Fig 2: Method of MPR for measuring mitral valve annulus area in systole and diastole.
Fig 4: Regurgitant Orifice area from MPR
Note the variation in the shape of venacontracta. Measuring the width shows enormous variation in diameter at different points, making the 2D venacontracta measurement unreliable.
Graph illustrating correlation between ROA and clinical severity score
Regurgitant Orifice Area is calculated from colour 3D MPR and plotted against Clinical Severity Score.
The inter observer variability for ROA was 0.966
and Intra observer variability was 0.952
Conclusion: Regurgitant orifice area as assessed by VCA indexed to body surface area gives the best correlation to the clinical severity of MR. This is highly reproducible
and useful for monitoring the severity of MR in children