IMR Press / RCM / Volume 23 / Issue 12 / DOI: 10.31083/j.rcm2312407
Open Access Review
Echocardiography in the Assessment of Valve Regurgitation– Incremental Role of Three Dimensional Echocardiography
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1 Department of Medicine, Banner University Medical Center, Phoenix, AZ 85719, USA
2 Department of Cardiovascular Disease, Division of Echocardiography, Mayo Clinic, Scottsdale, AZ 85259, USA
*Correspondence: (Tasneem Z Naqvi)
Academic Editor: Donato Mele
Rev. Cardiovasc. Med. 2022, 23(12), 407;
Submitted: 7 April 2022 | Revised: 19 July 2022 | Accepted: 21 July 2022 | Published: 14 December 2022
(This article belongs to the Special Issue Role of Echocardiography in Current Cardiology Practice)
Copyright: © 2022 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.

Echocardiography (Echo) has a primary role in the evaluation of cardiac valve regurgitation. Echo valve regurgitation assessment includes multiple qualitative and quantitative methods which require adequate image quality, comprehensive echocardiographic images and precise measurements to obtain accurate assessment. For patient management, it is also important to investigate the mechanism of valve regurgitation. Severity and mechanism of valve regurgitation determine whether continued medical follow up is optimal or surgical or percutaneous valve repair, or replacement option should be necessary. Transthoracic Echo (TTE) is the gold standard most commonly used for the assessment of valve leaflet anatomy, valve motion and regurgitation severity to determine primary versus secondary causes of valve regurgitation, however transesophageal echo (TEE) provides high resolution imaging of valve leaflets and supporting apparatus and oftentimes determines mechanism of valve regurgitation particularly for mitral and tricuspid valves when TTE is unable to determine the mechanism. By providing surgical type views in a moving heart under normal hemodynamic conditions, 3D TEE has greatly improved assessment of mechanism and etiology of valve regurgitation. Besides, TEE also allows quantitation of valve regurgitation severity by Doppler methods as well as direct 3D planimetry of valve area and regurgitant orifice area. Doppler methods are pre and afterload dependent whereas direct 3D planimetry allows assessment of location and severity of valve regurgitation irrespective of ventricular loading conditions. Pre or intraoperative 3D TEE assessment can provide valuable information for surgical planning of valve repair or replacement. This review discusses various valvular pathologies causing regurgitation and the role of TTE and TEE in improving this assessment as shown by several case examples.

valve regurgitation
valve repair
Doppler echocardiography
three-dimensional echocardiography
Fig. 1.
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