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Three-dimensional Echocardiography pp 109–154Cite as

Valvular heart disease – insufficiencies

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Abstract

Valvular insufficiencies are among the most frequent heart diseases [1, 2]. Valvular flow regurgitation causes a burden of volume overload to the heart which ultimately leads to progressive heart failure [3–5]. Improved understanding of the mechanism of valvular regurgitation is of critical importance for diagnostic and therapeutic patient management [6, 7]. In addition, accurate estimation of the severity of regurgitation was demonstrated to be of significant importance for patient management and prognosis [4, 8] and consequently has been widely recognized in recent guidelines [6, 7, 9]. However, evaluation of both the mechanism and severity of regurgitation can be potentially difficult with the largest challenges presenting in cases of mitral regurgitation.

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References

  1. Nkomo VT, Gardin JM, Skelton TN, Gottdiener JS, Scott CG, Enriquez-Sarano M (2006) Burden of valvular heart diseases: a population-based study. Lancet 368:1005–1011

    Article  PubMed  Google Scholar 

  2. Iung B, Baron G, Butchart EG, Delahaye F, Gohlke-Barwolf C, Levang OW, Tornos P, Vanoverschelde JL, Vermeer F, Boersma E, Ravaud P, Vahanian A (2003) A prospective survey of patients with valvular heart disease in Europe: The Euro Heart Survey on Valvular Heart Disease. Eur Heart J 24:1231–1243

    Article  PubMed  Google Scholar 

  3. Avierinos JF, Gersh BJ, Melton LJ, III, Bailey KR, Shub C, Nishimura RA, Tajik AJ, Enriquez-Sarano M (2002) Natural history of asymptomatic mitral valve prolapse in the community. Circulation 106:1355–1361

    Article  PubMed  Google Scholar 

  4. Enriquez-Sarano M, Avierinos JF, Messika-Zeitoun D, Detaint D, Capps M, Nkomo V, Scott C, Schaff HV, Tajik AJ (2005) Quantitative determinants of the outcome of asymptomatic mitral regurgitation. N Engl J Med 352:875–883

    Article  PubMed  CAS  Google Scholar 

  5. Zile MR (1991) Chronic aortic and mitral regurgitation. Clin Cardiol 9:239–253

    CAS  Google Scholar 

  6. Bonow RO, Carabello RA, Chatterjee K, de Leon AC, Faxon PF, Freed MD, Gaasch WH (2006) ACC/AHA 2006 guidelines for the management of patients with valvular heart disease. J Am Coll Cardiol 48:e1–e148

    Article  PubMed  Google Scholar 

  7. Vahanian A, Baumgartner H, Bax J, Butchart E, Dion R, Filippatos G, Flachskampf F, Hall R, Iung B, Kasprzak J, Nataf P, Tornos P, Torracca L, Wenink A, Priori SG, Blanc JJ, Budaj A, Camm J, Dean V, Deckers J, Dickstein K, Lekakis J, McGregor K, Metra M, Morais J, Osterspey A, Tamargo J, Zamorano JL, Angelini A, Antunes M, Fernandez MA, Gohlke-Baerwolf C, Habib G, McMurray J, Otto C, Pierard L, Pomar JL, Prendergast B, Rosenhek R, Uva MS, Tamargo J (2007) Guidelines on the management of valvular heart disease: The Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology. Eur Heart J 28:230–268

    PubMed  Google Scholar 

  8. Grigioni F, Enriquez-Sarano M, Zehr KJ, Bailey KR, Tajik AJ (2001) Ischemic mitral regurgitation: Long-term outcome and prognostic implications with quantitative Doppler assessment. Circulation 103:1759–1764

    PubMed  CAS  Google Scholar 

  9. Zoghbi WA, Enriquez-Sarano M, Foster E, Grayburn PA, Kraft CD, Levine RA, Nihoyannopoulos P, Otto CM, Quinones MA, Rakowski H, Stewart WJ, Waggoner A, Weissman NJ (2003) Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr 2003; 16:777–802

    Google Scholar 

  10. Lang RM, Mor-Avi V, Sugeng L, Nieman PS, Sahn DJ (2006) Three-dimensional echocardiography: the benefits of the additional dimension. J Am Coll Cardiol 48:2053–2069

    Article  PubMed  Google Scholar 

  11. Kahlert P, Plicht B, Schenk IM, Janosi RA, Erbel R, Buck T (2008) Direct assessment of size and shape of noncircular vena contracta area in functional versus organic mitral regurgitation using real-time three-dimensional echocardiography. J Am Soc Echocardiogr 21:912–921

    Article  PubMed  Google Scholar 

  12. Pepi M, Tamborini G, Maltagliati A, Galli CA, Sisillo E, Salvi L, Naliato M, Porqueddu M, Parolari A, Zanobini M, Alamanni F (2006) Head-to-head comparison of two- and three-dimensional transthoracic and transesophageal echocardiography in the localization of mitral valve prolapse. J Am Coll Cardiol 48:2524–2530

    Article  PubMed  Google Scholar 

  13. Grewal J, Mankad S, Freeman WK, Click RL, Suri RM, Abel MD, Oh JK, Pellikka PA, Nesbitt GC, Syed I, Mulvagh SL, Miller FA (2009) Real-time three-dimensional transesophageal echocardiography in the intraoperative assessment of mitral valve disease. J Am Soc Echocardiogr 22:34–41

    Article  PubMed  Google Scholar 

  14. Carabello BA (2004) Indications for mitral valve surgery. J Cardiovasc Surg (Torino) 45:407–418

    CAS  Google Scholar 

  15. Walther T, Falk V, Mohr FW (2004) Minimally invasive mitral valve surgery. J Cardiovasc Surg 45:487–495

    CAS  Google Scholar 

  16. Akins CW, Hilgenberg AD, Buckley MJ, Vlahakes GJ, Torchiana DF, Daggett WM, Austen WG (1994) Mitral-valve reconstruction versus replacement for degenerative or ischemic mitral regurgitation. Annals of Thoracic Surgery 58:668–676

    Article  PubMed  CAS  Google Scholar 

  17. Seeburger J, Falk V, Borger MA, Passage J, Walther T, Doll N, Mohr FW (2009) Chordae replacement versus resection for repair of isolated posterior mitral leaflet prolapse: a egalite. Ann Thorac Surg 87:1715–1720

    Article  PubMed  Google Scholar 

  18. Carpentier A (1983) Cardiac valve surgery - the “French correction”. J Thorac Cardiovasc Surg 86:323–337

    PubMed  CAS  Google Scholar 

  19. Salcedo EE, Quaife RA, Seres T, Carroll JD (2009) A framework for systematic characterization of the mitral valve by real-time three-dimensional transesophageal echocardiography. J Am Soc Echocardiogr 22:1087–1099

    Article  PubMed  Google Scholar 

  20. Carpentier A, Chauvaud S, Fabiani JN, Deloche A, Relland J, Lessana A, d'Allaines C, Blondeau P, Piwnica A, Dubost C (1980) Reconstructive surgery of mitral valve incompetence: ten-year appraisal. J Thorac Cardiovasc Surg 79:338–348

    PubMed  CAS  Google Scholar 

  21. Al-Radi OO, Austin PC, Tu JV, David TE, Yau TM (2005) Mitral repair versus replacement for ischemic mitral regurgitation. Ann Thorac Surg 79:1260–1267

    Article  PubMed  Google Scholar 

  22. Barlow JB, Pocock WA (1988) Mitral valve billowing and prolapse: perspective at 25 years. Herz 13:227–234

    PubMed  CAS  Google Scholar 

  23. Freed LA, Levy D, Levine RA, Larson MG, Evans JC, Fuller DL, Lehman B, Benjamin EJ (1999) Prevalence and clinical outcome of mitral-valve prolapse. N Engl J Med 341:1–7

    Article  PubMed  CAS  Google Scholar 

  24. Anyanwu AC, Adams DH (2007) Etiologic classification of degenerative mitral valve disease: Barlow's disease and fibroelastic deficiency. Semin Thorac Cardiovasc Surg 19:90–96

    Article  PubMed  Google Scholar 

  25. Ling LH, Enriquez-Sarano M, Seward JB, Tajik AJ, Schaff HV, Bailey KR, Frye RL (1996) Clinical outcome of mitral regurgitation due to flail leaflet. N Engl J Med 335:1417–1423

    Article  PubMed  CAS  Google Scholar 

  26. Foster GP, Isselbacher EM, Rose GA, Torchiana DF, Akins CW, Picard MH (1998) Accurate localization of mitral regurgitant defects using multiplane transesophageal echocardiography. Ann Thorac Surg 65:1025–1031

    Article  PubMed  CAS  Google Scholar 

  27. Carpentier A, Lessana A, Relland JYM, Belli E, Mihaileanu S, Berrebi AJ, Palsky E, Loulmet DF (1995) The “physio-ring”: an advanced concept in mitral valve annuloplasty. Ann Thorac Surg 60:1177–1186

    Article  PubMed  CAS  Google Scholar 

  28. O'Gara P, Sugeng L, Lang R, Sarano M, Hung J, Raman S, Fischer G, Carabello B, Adams D, Vannan M (2008) The role of imaging in chronic degenerative mitral regurgitation. JACC Cardiovasc Imaging 1:221–237

    Article  PubMed  Google Scholar 

  29. Mor-Avi V, Sugeng L, Lang RM (2009) Real-time 3-dimensional echocardiography: an integral component of the routine echocardiographic examination in adult patients? Circulation 119:314–329

    Article  PubMed  Google Scholar 

  30. Patel V, Hsiung MC, Nanda NC, Miller AP, Fang L, Yelamanchili P, Mehmood F, Gupta M, Duncan K, Singh A, Rajdev S, Fan P, Naftel DC, McGiffin DC, Pacifico AD, Kirklin JK, Lin CC, Yin WH, Young MS, Chang CY, Wei J (2006) Usefulness of live/real time three-dimensional transthoracic echocardiography in the identification of individual segment/scallop prolapse of the mitral valve. Echocardiography 23:513–518

    Article  PubMed  Google Scholar 

  31. Sharma R, Mann J, Drummond L, Livesey SA, Simpson IA (2007) The evaluation of real-time 3-dimensional transthoracic echocardiography for the preoperative functional assessment of patients with mitral valve prolapse: a comparison with 2-dimensional transesophageal echocardiography. J Am Soc Echocardiogr 20:934–940

    Article  PubMed  Google Scholar 

  32. Sugeng L, Shernan SK, Salgo IS, Weinert L, Shook D, Raman J, Jeevanandam V, DuPont F, Settlemier S, Savord B, Fox J, Mor-Avi V, Lang RM (2008) Live 3-dimensional transesophageal echocardiography: initial experience using the fully-sampled matrix array probe. J Am Coll Cardiol 52:446–449

    Article  PubMed  Google Scholar 

  33. Barlow JB, Bosman CK (1966) Aneurysmal protrusion of the posterior leaflet of the mitral valve. An auscultatory-electrocardiographic syndrome. Am Heart J 71:166–178

    Article  PubMed  CAS  Google Scholar 

  34. Hayek E, Gring CN, Griffin BP (2005) Mitral valve prolapse. Lancet 365:507–518

    PubMed  Google Scholar 

  35. Tanaka K, Takeda M (2004) Repair of Barlow's mitral valve: to do or not to do. Ann Thorac Surg 78:1879–1880

    Article  PubMed  Google Scholar 

  36. Fornes P, Heudes D, Fuzellier JF, Tixier D, Bruneval P, Carpentier A (1999) Correlation between clinical and histologic patterns of degenerative mitral valve insufficiency: a histomorphometric study of 130 excised segments. Cardiovasc Pathol 8:81–92

    Article  PubMed  CAS  Google Scholar 

  37. Sugeng L, Shernan SK, Weinert L, Shook D, Raman J, Jeevanandam V, DuPont F, Fox J, Mor-Avi V, Lang RM (2008) Real-time three-dimensional transesophageal echocardiography in valve disease: comparison with surgical findings and evaluation of prosthetic valves. J Am Soc Echocardiogr 21:1347–1354

    Article  PubMed  Google Scholar 

  38. Otsuji Y, Handschumacher MD, Schwammenthal E, Jiang L, Song JK, Guerrero JL, Vlahakes GJ, Levine RA (1997) Insights from three-dimensional echocardiography into the mechanism of functional mitral regurgitation: direct in vivo demonstration of altered leaflet tethering geometry. Circulation 96:1999– 2008

    PubMed  CAS  Google Scholar 

  39. Hung J, Otsuji Y, Handschmacher MD, Schwammenthal E, Levine RA (1999) Mechanism of dynamic regurgitant orifice area variation in functional mitral regurgitation: physiologic insights from the proximal flow convergence technique. J Am Coll Cardiol 33:538–545

    Article  PubMed  CAS  Google Scholar 

  40. Calafiore AM, Gallina S, Di Mauro M, Gaeta F, Iaco AL, D'Alessandro S, Mazzei V, Di Giammarco G (2001) Mitral valve procedure in dilated cardiomyopathy: repair or replacement? Ann Thorac Surg 71:1146–1152

    Article  PubMed  CAS  Google Scholar 

  41. Yamauchi T, Taniguchi K, Kuki S, Masai T, Noro H, Nishino M, Fujita S (2004) Evaluation of the mitral valve leaflet morphology after mitral valve reconstruction with a concept “coaptation length index”. J Card Surg 19:535–538

    Article  PubMed  Google Scholar 

  42. Watanabe N, Ogasawara Y, Yamaura Y, Yamamoto K, Wada N, Kawamoto T, Toyota E, Akasaka T, Yoshida K (2006) Geometric differences of the mitral valve tenting between anterior and inferior myocardial infarction with significant ischemic mitral regurgitation: quantitation by novel software system with transthoracic real-time three-dimensional echocardiography. J Am Soc Echocardiogr 19:71–75

    Article  PubMed  Google Scholar 

  43. Watanabe N, Ogasawara Y, Yamaura Y, Kawamoto T, Toyota E, Akasaka T, Yoshida K (2005) Quantitation of mitral valve tenting in ischemic mitral regurgitation by transthoracic real-time threedimensional echocardiography. J Am Coll Cardiol 45:763–769

    Article  PubMed  Google Scholar 

  44. Song JM, Fukuda S, Kihara T, Shin MS, Garcia MJ, Thomas JD, Shiota T (2006) Value of mitral valve tenting volume determined by real-time three-dimensional echocardiography in patients with functional mitral regurgitation. Am J Cardiol 98:1088– 1093

    Article  PubMed  Google Scholar 

  45. Yamaura Y, Watanabe N, Ogasawara Y, Wada N, Kawamoto T, Toyota E, Akasaka T, Tanemoto K, Yoshida K (2005) Geometric change of mitral valve leaflets and annulus after reconstructive surgery for ischemic mitral regurgitation: real-time 3-dimensional echocardiographic study. J Thorac Cardiovasc Surg 130:1459–1461

    Article  PubMed  Google Scholar 

  46. Ryan LP, Jackson BM, Parish LM, Sakamoto H, Plappert TJ, St John-Sutton M, Gorman JH, III, Gorman RC (2007) Mitral valve tenting index for assessment of subvalvular remodeling. Ann Thorac Surg 84:1243–1249

    Article  PubMed  Google Scholar 

  47. Yamada R, Watanabe N, Kume T, Tsukiji M, Kawamoto T, Neishi Y, Hayashida A, Toyota E, Okura H, Yoshida K (2009) Quantitative measurement of mitral valve coaptation in functional mitral regurgitation: in vivo experimental study by real-time threedimensional echocardiography. J Cardiol 53:94–101

    Article  PubMed  Google Scholar 

  48. Daniel WG, Flachskampf FA (2006) Infective endocarditis. In: Camm AJ, Lüscher TF, Serruys PW (eds) The ESC textbook of cardiovascular medicine. Malden, Massachusetts, USA: Blackwell Publishing, pp 671–684

    Google Scholar 

  49. Kronzon I, Sugeng L, Perk G, Hirsh D, Weinert L, Garcia Fernandez MA, Lang RM (2009) Real-time 3-dimensional transesophageal echocardiography in the evaluation of post-operative mitral annuloplasty ring and prosthetic valve dehiscence. J Am Coll Cardiol 53:1543–1547

    Article  PubMed  Google Scholar 

  50. Click RL, Abel MD, Schaff HV (2000) Intraoperative transesophageal echocardiography: 5-year prospective review of impact on surgical management. Mayo Clin Proc 75:241–247

    Article  PubMed  CAS  Google Scholar 

  51. Freeman WK, Schaff HV, Khandheria BK, Oh JK, Orszulak TA, Abel MD, Seward JB, Tajik AJ (19929 Intraoperative evaluation of mitral valve regurgitation and repair by transesophageal echocardiography: incidence and significance of systolic anterior motion. J Am Coll Cardiol 20:599–609

    Google Scholar 

  52. Niwa Y, Yoshida K, Akasaka T, Hozumi T, Yamaura Y, Okada Y, Shomura T, Yoshikawa J (1996) [Intraoperative assessment of mitral valve plasty by transesophageal echocardiography]. J Cardiol 28:155–159

    PubMed  CAS  Google Scholar 

  53. Sinha A, Kasliwal RR, Nanda NC, Chauhan N, Agrawal G, Khanna D, Dod HS (2004) Live three-dimensional transthoracic echocardiographic assessment of isolated cleft mitral valve. Echocardiography 21:657–661

    Article  PubMed  Google Scholar 

  54. Kuperstein R, Feinberg MS, Carasso S, Gilman S, Dror Z, Di Segni E (2006) The added value of real-time 3-dimensional echocardiography in the diagnosis of isolated cleft mitral valve in adults. J Am Soc Echocardiogr 19:811–814

    Article  PubMed  Google Scholar 

  55. Anwar AM, McGhie JS, Meijboom FJ, Ten Cate FJ (2008) Double orifice mitral valve by real-time three-dimensional echocardiography. Eur J Echocardiogr 9:731–732

    Article  PubMed  Google Scholar 

  56. Buck T, Plicht B, Erbel R (2006) [Current recommendations on echocardiographic evaluation of the severity of mitral regurgitation: standardization and practical application using a scoring system]. Herz 31:30–37

    Article  PubMed  Google Scholar 

  57. Yoganathan AP, Cape EG, Sung HW, Williams FP, Jimoh A (1988) Review of hydrodynamic principles for the cardiologist: applications to the study of blood flow and jets by imaging techniques. J Am Coll Cardiol 12:1344–1353

    Article  PubMed  CAS  Google Scholar 

  58. Mascherbauer J, Rosenhek R, Bittner B, Binder T, Simon P, Maurer G, Schima H, Baumgartner H (2005) Doppler echocardiographic assessment of valvular regurgitation severity by measurement of the vena contracta: an in vitro validation study. J Am Soc Echocardiogr 18:999–1006

    Article  PubMed  Google Scholar 

  59. Baumgartner H, Schima H, Kuhn P (1991) Value and limitations of proximal jet dimensions for the quantitation of valvular regurgitation: an in vitro study using Doppler flow imaging. J Am Soc Echocardiogr 4:57–66

    PubMed  CAS  Google Scholar 

  60. Fehske W, Omran H, Manz M, Kohler J, Hagendorff A, Luderitz B (1994) Color-coded Doppler imaging of the vena contracta as a basis for quantification of pure mitral regurgitation. Am J Cardiol 73:268–274

    Article  PubMed  CAS  Google Scholar 

  61. Mele D, Vandervoort PM, Palacios IF, Rivera JM, Dinsmore RE, Schwammenthal E, Marshall JE, Weyman AE, Levine RA (1995) Proximal jet size by Doppler color flow mapping predicts severity of mitral regurgitation: clinical studies. Circulation 91:746–754

    PubMed  CAS  Google Scholar 

  62. Hall SA, Brickner ME, Willett DL, Irani WN, Afridi I, Grayburn PA (1997) Assessment of mitral regurgitation severity by Doppler color flow mapping of the vena contracta. Circulation 95:636– 642

    PubMed  CAS  Google Scholar 

  63. Schwammenthal E, Chen C, Benning E, Block M, Breithardt G, Levine RA (1994) Dynamics of mitral regurgitant flow and orifice area: Physiologic application of the proximal flow convergence method. Circulation 90:307–322

    PubMed  CAS  Google Scholar 

  64. Khanna D, Vengala S, Miller AP, Nanda NC, Lloyd SG, Ahmed S, Sinha A, Mehmood F, Bodiwala K, Upendram S, Gownder M, Dod HS, Nunez A, Pacifico AD, McGiffin DC, Kirklin JK, Misra VK (2004) Quantification of mitral regurgitation by live three-dimensional transthoracic echocardiographic measurements of vena contracta area. Echocardiography 21:737–743

    Article  PubMed  Google Scholar 

  65. Marsan NA, Westenberg JJ, Ypenburg C, Delgado V, van Bommel RJ, Roes SD, Nucifora G, van der Geest RJ, de Roos A, Reiber JC, Schalij MJ, Bax JJ (2009) Quantification of functional mitral regurgitation by real-time 3D echocardiography: comparison with 3D velocity-encoded cardiac magnetic resonance. JACC Cardiovasc Imaging 2:1245–1252

    Article  PubMed  Google Scholar 

  66. Plicht B, Kahlert P, Goldwasser R, Janosi RA, Hunold P, Erbel R, Buck T (2008) Direct quantification of mitral regurgitant flow volume by real-time three-dimensional echocardiography using dealiasing of color Doppler flow at the vena contracta. J Am Soc Echocardiogr 21:1337–1346

    Article  PubMed  Google Scholar 

  67. Skaug TR, Hergum T, Amundsen BH, Skjaerpe T, Torp H, Haugen BO (2010) Quantification of mitral regurgitation using high pulse repetition frequency three-dimensional color Doppler. J Am Soc Echocardiogr 23:1–8

    Article  PubMed  Google Scholar 

  68. Recusani F, Bargiggia GS, Yoganathan AP, Raisaro A (1991) A new method for quantification of regurgitant flow rate using color flow imaging of the flow convergence region proximal to a discrete orifice: an vitro study. Circulation 83:594–604

    PubMed  CAS  Google Scholar 

  69. Utsunomiya T, Ogawa T, Doshi R, Patel D, Quan M, Henry WL, Gardin JM (1991) Doppler color flow “proximal isovelocity surface area” method for estimating volume flow rate: effects of orifice shape and machine factors. J Am Coll Cardiol 17:1103–1111

    Article  PubMed  CAS  Google Scholar 

  70. Iwakura K, Ito H, Kawano S, Okamura A, Kurotobi T, Date M, Inoue K, Fujii K (2006) 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 97:1630–1637

    Article  PubMed  Google Scholar 

  71. Buck T, Jansen CHP, Yoganathan AP, Levine RA, Handschumacher MD (1998) Hemisphere versus hemiellipse: when is each most accurate for proximal isovelocity calculation of regurgitant flows. (abstr). J Am Coll Cardiol 31:385A

    Article  Google Scholar 

  72. Yosefy C, Levine RA, Solis J, Vaturi M, Handschumacher MD, Hung J (2007) Proximal flow convergence region as assessed by real-time 3-dimensional echocardiography: challenging the hemispheric assumption. J Am Soc Echocardiogr 20:389–396

    Article  PubMed  Google Scholar 

  73. Matsumura Y, Saracino G, Sugioka K, Tran H, Greenberg NL, Wada N, Toyono M, Fukuda S, Hozumi T, Thomas JD, Yoshikawa J, Yoshiyama M, Shiota T (2008) Determination of regurgitant orifice area with the use of a new three-dimensional flow convergence geometric assumption in functional mitral regurgitation. J Am Soc Echocardiogr 21:1251–1256

    Article  PubMed  Google Scholar 

  74. Khoury G, Glineur D, Rubay J, Verhelst R, d'Acoz Y, Poncelet A, Astarci P, Noirhomme P, van Dyck M (2005) Functional classification of aortic root/valve abnormalities and their correlation with etiologies and surgical procedures. Curr Opin Cardiol 20:115–121

    Article  PubMed  Google Scholar 

  75. Thomas JD, Liu CM, Flachskampf FA, O'Shea JP, Davidoff R, Weyman AE (1990) Quantification of jet flow by momentum analysis: an in vitro color Doppler flow study. Circulation 81:247–259

    Article  PubMed  CAS  Google Scholar 

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  1. Department of Cardiology, Echocardiography West German Heart Center Essen, University Hospital Essen, Essen, Germany

    Thomas Buck MD, FACC, FESC (Associate Professor of Medicine Assistant Director, Director)

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Editors and Affiliations

  1. Department of Cardiology, Echocardiography West German Heart Center Essen, University Hospital Essen, Essen, Germany

    Thomas Buck MD, FACC, FESC (Associate Professor of Medicine Assistant Director, Director) (Associate Professor of Medicine Assistant Director, Director)

  2. Department of Cardiology, Angiology and Intensive Care Medicine, Klinikum Region Hannover – Klinikum Siloah, Hannover, Germany

    Andreas Franke MD, FESC (Associate Professor of Medicine Head) (Associate Professor of Medicine Head)

  3. Noninvasive Cardiology, King’s College Hospital London, London, UK

    Mark J. Monaghan PhD, FRCP(Hon), FACC, FESC (Professor of Echocardiography Director) (Professor of Echocardiography Director)

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Buck, T. (2011). Valvular heart disease – insufficiencies. In: Buck, T., Franke, A., Monaghan, M.J. (eds) Three-dimensional Echocardiography. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-11179-2_8

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