Rheumatic Mitral Valve Diseases and Mitral Annular Calcification: Role of 3DE

Abstract

Direct measurement of the mitral valve (MV) orifice has emerged as the preferred method for assessment of rheumatic mitral stenosis (MS) severity and forms the basis for guideline driven therapy. 3D echocardiography (3DE) provides enface views of the MV from both the left atrium and left ventricle. Using multiplanar reconstruction (MPR), the two-dimensional (2D) tomographic planes in the 3D space can be precisely aligned with the tips of the MV so that the true anatomic valve area can be measured thus obviating the errors associated with conventional 2D echocardiographic (2DE) hand-held scanning of the MV in the short-axis view to determine the optimal orifice at the leaflet tips for area planimetry. 3DE is also better than 2DE at assessment of the mitral commissures including extent of commissural thickening and detection of commissural calcification, important considerations for percutaneous mitral balloon valvuloplasty. Mitral annular calcification (MAC) is also better visualized in the 3D space and, in patients undergoing percutaneous mitral valve-in-valve implantation, measurement of mitral annular dimensions using MPR can be very useful in determining the transcatheter heart valve size. Quantitative MPR also has a complimentary role to 2DE in assessment of MR severity in patients with rheumatic mitral valve disease or MAC.