Real-time 3D transesophageal echocardiography for the evaluation of rheumatic mitral stenosis

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Objectives: The aims of this study were: 1) to assess the feasibility and reliability of performing mitral valve area (MVA) measurements in patients with rheumatic mitral valve stenosis (RhMS) using real-time 3-dimensional transesophageal echocardiography (3DTEE) planimetry (MVA 3D); 2) to compare MVA 3D with conventional techniques: 2-dimensional (2D) planimetry (MVA 2D), pressure half-time (MVA PHT), and continuity equation (MVA CON); and 3) to evaluate the degree of mitral commissural fusion. Background: 3DTEE is a novel technique that provides excellent image quality of the mitral valve. Real-time 3DTEE is a relatively recent enhancement of this technique. To date, there have been no feasibility studies investigating the utility of real-time 3DTEE in the assessment of RhMS. Methods: Forty-three consecutive patients referred for echocardiographic evaluation of RhMS and suitability for percutaneous mitral valvuloplasty were assessed using 2D transthoracic echocardiography and real-time 3DTEE. MVA 3D, MVA 2D, MVA PHT, MVA CON, and the degree of commissural fusion were evaluated. Results: MVA 3D assessment was possible in 41 patients (95%). MVA 3D measurements were significantly lower compared with MVA 2D (mean difference: -0.16 ± 0.22; n = 25, p < 0.005) and MVA PHT (mean difference: -0.23 ± 0.28 cm 2; n = 39, p < 0.0001) but marginally greater than MVA CON (mean difference: 0.05 ± 0.22 cm 2; n = 24, p = 0.82). MVA 3D demonstrated best agreement with MVA CON (intraclass correlation coefficient [ICC] 0.83), followed by MVA 2D (ICC 0.79) and MVA PHT (ICC 0.58). Interobserver and intraobserver agreement was excellent for MVA 3D, with ICCs of 0.93 and 0.96, respectively. Excellent commissural evaluation was possible in all patients using 3DTEE. Compared with 3DTEE, underestimation of the degree of commissural fusion using 2D transthoracic echocardiography was observed in 19%, with weak agreement between methods (κ < 0.4). Conclusions: MVA planimetry is feasible in the majority of patients with RhMS using 3DTEE, with excellent reproducibility, and compares favorably with established methods. Three-dimensional transesophageal echocardiography allows excellent assessment of commissural fusion. © 2011 American College of Cardiology Foundation.




Schlosshan, D., Aggarwal, G., Mathur, G., Allan, R., & Cranney, G. (2011). Real-time 3D transesophageal echocardiography for the evaluation of rheumatic mitral stenosis. JACC: Cardiovascular Imaging, 4(6), 580–588.

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