Initial Experience With Automated 3D Color Flow Quantification of Mitral Regurgitation

Accurate quantification of mitral regurgitation (MR) is essential for preprocedural evaluation and intraprocedural decision-making during transcatheter mitral interventions. Conventional echocardiographic techniques, such as the proximal isovelocity surface area method, have numerous limitations. Proximal isovelocity surface area is sensitive to the timing of MR, orifice geometry, and jet eccentricity. Assumptions of hemispheric flow convergence and circular regurgitant orifices are often untrue, particularly in functional MR. As a result, nonholosystolic jets may lead to overestimation of MR severity, while multiple jets may cause underestimation. To overcome these limitations, we describe our initial experience with the Philips 3D Automated Color Flow Quantification tool, used to focus on optimal image acquisition strategies and common pitfalls. This software enables automated calculation of regurgitant volume directly from 3D color Doppler data, allowing assessment of multiple and noncircular MR origins. By integrating a fluid dynamics model with artificial intelligence-based segmentation, the tool performs frame-by-frame systolic analysis, capturing temporal variations in regurgitant flow throughout systole. Our study included patients with severe MR undergoing transcatheter edge-to-edge repair; MR quantification is important for both procedural planning and intraprocedural guidance with this population. Although further validation is needed before widespread adoption, accurate analysis is highly dependent on high-quality 3D color Doppler acquisition. This manuscript outlines key technical considerations for optimizing 3D color imaging-including balancing spatial resolution and temporal resolution, increasing frame rate, and addressing common analysis challenges-with illustrative figures and supplemental videos.