Three-dimensional echocardiographic analysis of valve anatomy as a determinant of mitral regurgitation after surgery for atrioventricular septal defects

• Published in: The American journal of cardiology 1999-03, Vol.83 (5), p.745-749
• Main Authors: Acar, Philippe, Laskari, Cleo, Rhodes, Jonathan, Pandian, Natesa, Warner, Ken, Marx, Gerald
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Anatomy & physiology; Biological and medical sciences; Cardiology; Cardiovascular system; Child; Child, Preschool; Doppler effect; Down Syndrome - complications; Echocardiography; Echocardiography, Doppler, Color; Echocardiography, Three-Dimensional; Echocardiography, Transesophageal; Feasibility Studies; Female; Heart Septal Defects, Atrial - surgery; Heart Septal Defects, Ventricular - surgery; Humans; Image Processing, Computer-Assisted; Infant; Investigative techniques, diagnostic techniques (general aspects); Linear Models; Male; Medical sciences; Mitral Valve - diagnostic imaging; Mitral Valve Insufficiency - diagnostic imaging; Observer Variation; Postoperative Complications - diagnostic imaging; Prospective Studies; Single-Blind Method; Surgery; Ultrasonic investigative techniques
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/S0002-9149(98)00982-5

Mitral regurgitation (MR) is a significant complication after atrioventricular septal defect (AVSD) surgery. The relation of the valve leaflet morphology and the MR mechanism remains a conundrum. Two-dimensional echocardiography depicts leaflet edges, whereas volume-rendered 3-dimensional echocardiography provides direct visualization of the surface areas of the mitral valve leaflets. This study examines the relation of mitral valve anatomy as determined by 3-dimensional echocardiography with MR origins in patients after AVSD repair. Twenty-seven patients with AVSD surgery and Doppler color MR were prospectively enrolled (median age was 5 years and 16 patients had Down syndrome). Doppler color flow imaging of the MR jet and 3-dimensional echocardiography of the mitral valve were performed with a probe in the transthoracic or transesophageal position. Enface 3-dimensional views of the mitral valve from the left atrium were reconstructed. Analysis of the 3-dimensional data was possible in 21 of the 27 patients. Mean area ratios of the 3 mitral leaflets were calculated (superior 40 ± 7%, inferior 35 ± 5%, mural 25 ± 6%). Both intra and interobserver variability on the area measurements were