State-of-the-Art Paper
Valvular Heart Disease: The Value of 3-Dimensional Echocardiography

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Significant advances in 3-dimensional echocardiography (3DE) technology have ushered its use into clinical practice. The recent advent of real-time 3DE using matrix array transthoracic and transesophageal transducers has resulted in improved image spatial resolution, and therefore, enhanced visualization of the pathomorphological features of the cardiac valves compared with previously used sparse array transducers. It has enabled an unparalleled real-time visualization of valves and subvalvular anatomic features from a single volume acquisition without the need for offline reconstruction. On-cart or offline post-processing using commercially available and custom 3-dimensional analysis software allows the quantification of multiple parameters, such as orifice area, prolapse height and volume in mitral valve disease, area of the left ventricular outflow tract, and tricuspid annular geometry. In this review, we discuss the incremental role of 3DE in evaluating valvular anatomic features, volumetric quantification, pre-surgical planning, intraprocedural guidance, and post-procedural assessment of valvular heart disease.

Key Words

aortic valve
mitral valve
pulmonic valve
three-dimensional echocardiography
tricuspid valve
valvular heart disease

Abbreviations and Acronyms

2D
2-dimensional
2DE
2-dimensional echocardiography
3D
3-dimensional
3DE
3-dimensional echocardiography
AV
aortic valve
AVA
aortic valve area
EROA
effective regurgitant orifice
LV
left ventricle
LVOT
left ventricular outflow tract
MR
mitral regurgitation
MV
mitral valve
PBMV
percutaneous balloon mitral valvuloplasty
PISA
proximal isovelocity surface area
PM
papillary muscle
PV
pulmonary valve
RV
right ventricle
SAM
systolic anterior motion
TEE
transesophageal echocardiography
TTE
transthoracic echocardiography
TR
tricuspid regurgitation
TV
tricuspid valve
VC
vena contracta

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Dr. Tsang is funded through a Canadian Institute of Health Research research fellowship grant. All authors have reported that they have no relationships relevant to the contents of this paper to disclose. Drs. Tsang and Chandra contributed equally to this work.