Valvular Heart Disease
Comparison of Vena Contracta Width by Multiplane Transesophageal Echocardiography With Quantitative Doppler Assessment of Mitral Regurgitation

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Abstract

Mitral regurgitation (MR) severity is routinely assessed by Doppler color flow mapping, which is subject to technical and hemodynamic variables. Vena contracta width may be less influenced by hemodynamic variables and has previously been shown to correlate with angiographic estimates of MR severity. This study was performed to compare mitral vena contracta width by multiplane transesophageal echocardiography (TEE) with simultaneous quantitative Doppler echocardiography in 35 patients with MR. The vena contracta width was measured at the narrowest portion of the MR jet as it emerged through the coaptation of the leaflets; it was identified in 97% of the patients. Vena contracta width correlated well with regurgitant volume (R2 = 0.81) and regurgitant orifice area (R2 = 0.81) by quantitative Doppler technique. A vena contracta width ≥0.5 cm always predicted a regurgitant volume >60 ml and an effective regurgitant orifice area ≥0.4 cm2 in all patients. A vena contracta width ≤0.3 cm always predicted a regurgitant volume <45 ml and a regurgitant orifice area ≤0.35 cm2. Thus, vena contracta width by multiplane TEE correlates well with mitral regurgitant volume and regurgitant orifice area by quantitative Doppler echocardiography and provides a simple method for the identification of patients with severe MR.

Section snippets

Patient Group:

We prospectively studied 35 patients with MR who were referred for TEE at Parkland Memorial Hospital (n = 24) or the Dallas VA Medical Center (n = 11). Patients were excluded from the study if they had aortic regurgitation or stenosis, significant mitral stenosis, acute myocardial infarction, and a mechanical or bioprosthetic valve. Of the 36 patients who were initially enrolled, only 1 patient was excluded due to inability to measure the mitral or aortic annulus. Patients ranged in age from 23

Transthoracic Echocardiography:

MR jets were eccentric in 19 patients and central in 16 patients. The mean mitral time–velocity integral in 28 of the 35 patients was 130 ± 28 cm (range 76 to 170). The time–velocity integral could not be obtained in 8 patients due to technical difficulty. The mean regurgitant volume was 74 ± 54 ml (range 6 to 189). The mean regurgitant fraction was 0.53 ± 0.20 (range 0.08 to 0.82). The mean effective orifice area in the 28 patients for whom the time–velocity integral was obtained was 0.69 ±

Discussion

Previous studies have reported that vena contracta width may be a useful method to assess the severity of MR. The present study is the first to compare simultaneous measurements of vena contracta width by multiplane TEE with quantitative Doppler measurements of regurgitant volume and effective regurgitant orifice area. Previous investigators have measured vena contracta width and proximal MR jet size by transthoracic echocardiography and reported larger discriminative values to identify severe

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