The Clinical Application Of Real-time Three-dimensional Echocardiography In Rheumatic Mitral Valve Stenosis

Background: Mitral stenosis (MS)is the most common rheumatic heart diseases (RHD). Exactly assessment of the degree of mitral valve orifice area and its surrounding structures was essential for the clinical management of the patient. At present, traditional echocardiography has some limits by the imaging principle. However , real-time three-dimensional echocardiography (RT-3DE)could instant provide a"en-face"view of the complete mitral valve apparatus and improve the accuracy of mitral valve orifice area (MVA) planimetry in three dimensional image processing software. It enables acquire plentiful and reliable diagnostic information and has more advantage than 2DE.Objective: Our aim was to assess the feasibility and accuracy of real-time three-dimensional echocardiography for the quantification of mitral valve orifice area in patients with rheumatic mitral valve stenosis.Methods: Thirty patients with rheumatic mitral valve stenosis (12 male,18 female,29 to 68 years)underwent surgical treatment. Before the operation, MVA were recorded with two dimensional echocardiography ( 2DE ) , pressure half-time ( PHT ) , real-time three-dimensional echocardiography biplane imaging ( RT-BP-3DE ) , and real-time three-dimensional echocardiography full-volume imaging (RT-FV-3DE)in all patients. The maximal MVA of mitral specimen was measured after the operation (OP), and it was compared with MVA acquired from abovementioned echocardiographic methods.Results: (1)The echocardiography images of all the cases were obtained optimally. RT-FV-3DE could show an"en-face"view of mitral valve stenosis and its neighbor relationship and improve the accuracy of MVA planimetry. (2)The correlation among RT-BP-3DE, RT-FV-3DE and OP about the MVA (r = 0.94, r = 0.99) were better than that among 2DE, PHT and OP (r = 0.93,r= 0.87). The Bland Altman plot indicated that the MVA derived from RT-FV-3DE and that derived from OP was rather consistent. For MVA measured by RT-FV-3DE,intraobserver and interobservers correlations were excellent (r = 0.94 ,r = 0.91)and no statistical difference was found in them(P > 0.05). Conclusions: RT-FV-3DE can provide more spatial information than other echo-methods in mitral valve stenosis. RT-FV-3DE is an accurate,feasible and reproducible method for assessing MVA in patients with mitral stenosis.