Quantitation of valve regurgitation severity by three‐dimensional vena contracta area is superior to flow convergence method of quantitation on transesophageal echocardiography

<jats:sec><jats:title>Background</jats:title><jats:p>Quantitation of regurgitation severity using the proximal isovelocity acceleration (<jats:styled-content style="fixed-case">PISA</jats:styled-content>) method to calculate effective regurgitant orifice (<jats:styled-content style="fixed-case">ERO</jats:styled-content>) area has limitations. Measurement of three‐dimensional (3D) vena contracta area (<jats:styled-content style="fixed-case">VCA</jats:styled-content>) accurately grades mitral regurgitation (<jats:styled-content style="fixed-case">MR</jats:styled-content>) severity on transthoracic echocardiography (<jats:styled-content style="fixed-case">TTE</jats:styled-content>).</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>We evaluated 3D <jats:styled-content style="fixed-case">VCA</jats:styled-content> quantitation of regurgitant jet severity using 3D transesophageal echocardiography (<jats:styled-content style="fixed-case">TEE</jats:styled-content>) in 110 native mitral, aortic, and tricuspid valves and six prosthetic valves in patients with at least mild valvular regurgitation. The <jats:styled-content style="fixed-case">ASE</jats:styled-content>‐recommended integrative method comprising semiquantitative and quantitative assessment of valvular regurgitation was used as a reference method, including <jats:styled-content style="fixed-case">ERO</jats:styled-content> area by 2D <jats:styled-content style="fixed-case">PISA</jats:styled-content> for assigning severity of regurgitation grade.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Mean age was 62.2±14.4 years; 3D <jats:styled-content style="fixed-case">VCA</jats:styled-content> quantitation was feasible in 91% regurgitant valves compared to 78% by the <jats:styled-content style="fixed-case">PISA</jats:styled-content> method. When both methods were feasible and in the presence of a single regurgitant jet, 3D <jats:styled-content style="fixed-case">VCA</jats:styled-content> and 2D <jats:styled-content style="fixed-case">PISA</jats:styled-content> were similar in differentiating assigned severity (<jats:styled-content style="fixed-case">ANOVA</jats:styled-content><jats:italic>P</jats:italic><.001). In valves with multiple jets, however, 3D <jats:styled-content style="fixed-case">VCA</jats:styled-content> had a better correlation to assigned severity (<jats:styled-content style="fixed-case">ANOVA</jats:styled-content><jats:italic>P</jats:italic><.0001). The agreement of 2D <jats:styled-content style="fixed-case">PISA</jats:styled-content> and 3D <jats:styled-content style="fixed-case">VCA</jats:styled-content> with the integrative method was 47% and 58% for moderate and 65% and 88% for severe regurgitation, respectively.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>Measurement of 3D <jats:styled-content style="fixed-case">VCA</jats:styled-content> by <jats:styled-content style="fixed-case">TEE</jats:styled-content> is superior to the 2D <jats:styled-content style="fixed-case">PISA</jats:styled-content> method in determination of regurgitation severity in multiple native and prosthetic valves.</jats:p></jats:sec>