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Published on: October 28, 2020
3D Echocardiography Is More Efficient In Detail Assessment of Calcification in Chronic Rheumatic Mitral Stenosis
S S Shakil1, D F Osmany, A K Biswas
1Dr Shiblee Sadeque Shakil, Senior Consultant, Department of Cardiology, Mymensingh Medical College Hospital, Mymensingh, Bangladesh;
Insights
Three-dimensional echocardiography (3DE) offers superior imaging for assessing rheumatic mitral stenosis severity and calcification, aiding treatment decisions. This advanced technique better detects commissural involvement compared to traditional 2D methods.
Area of Science:
- Cardiology
- Medical Imaging
- Echocardiography
Background:
- Rheumatic heart disease remains a significant cause of morbidity and mortality, particularly in South Asia.
- Rheumatic mitral stenosis is a common complication, requiring accurate assessment for effective treatment.
- Traditional echocardiography methods have limitations in fully evaluating calcification extent and distribution.
Purpose of the Study:
- To compare the efficacy of 2D and 3D echocardiography in assessing rheumatic mitral stenosis severity.
- To evaluate the role of 3D echocardiography in detailing calcification and commissural involvement.
- To determine the potential of 3D echocardiography in guiding therapeutic decisions for chronic rheumatic mitral stenosis.
Main Methods:
- A cross-sectional observational study involving 50 subjects with rheumatic mitral valve disease.
- Transthoracic 2D and 3D echocardiography were performed for detailed assessment.
- Comparative analysis of measurements, including mitral valve area and calcification assessment, between 2DE and 3DE.
Main Results:
- Mitral valve area measurements were comparable between 2D and 3D echocardiography (0.98±0.24cm² vs. 0.92±0.23cm²).
- 3D echocardiography demonstrated superior detection of calcification and commissural involvement (p=0.002).
- 3DE provides more detailed imaging crucial for accurate severity assessment.
Conclusions:
- Three-dimensional echocardiography offers enhanced visualization for assessing rheumatic mitral stenosis severity and calcification.
- 3DE's ability to detect commissural involvement is critical for treatment planning.
- 3D echocardiography shows promising prospects for optimizing management strategies in rheumatic mitral stenosis.
Abstract:
Rheumatic heart disease is in the declining phase, with the increase of urbanization and increment of availability of healthcare facility. However still it causes a substantial number of morbidity and mortality in South Asia. The prevalence of Rheumatic Fever and Rheumatic heart disease in Bangladesh is still high, 0.6 and 0.3 per thousand populations respectively. In the rheumatic process mitral is the frequently involved valve, mostly in the form of mitral stenosis. Choice of a treatment modality and its success largely depend on the accurate assessment of severity of disease especially the extent and distribution of calcification. Echocardiography has a key role in the determination of the severity of mitral stenosis as well as assessment of details calcification. Conventionally 2 dimensional and Doppler echocardiography is used. Now a days, 3D echocardiography offers better cardiac imaging for detail evaluation. The heart being a complex structure, the 3D evaluation would certainly offer better imaging for the accurate assessment of the mitral stenosis, especially details of presence & distribution calcification. This cross-sectional observational study was done from May 2012 to October 2012 in University Cardiac Centre, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. Data were collected with informed written consent, from 50 subjects who underwent transthoracic 2D and 3D Echocardiography for the assessment of rheumatic mitral valve with special emphasis on accurate assessment of severity, extent and distribution of calcification. Precise measurement of MV area is essential in the assessment of severity, which is found comparable by both 2DE (0.98±0.24cm²) and 3DE (0.92±0.23cm²). But in identifying calcification and accurate assessment of severity, more importantly commissural involvement is better detected by 3DE (p=0.002). This has extreme importance in therapeutic decision making in the treatment of chronic rheumatic MS. So, to formulate an efficient management plan, three-dimensional echocardiography has promising prospects in detecting severity & extent of rheumatic calcification.
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