Poduval Devika, Jose Reshmi L, Madathil Thushara, Nagarjuna P, Kartha Niveditha, Varma Praveen, Neema Praveen Kumar
Department of Cardiac Anaesthesia, Amrita Institute of Medical Sciences, Kochi, Kerala, India.
Department of Biostatistics, Amrita Institute of Medical Sciences, Kochi, Kerala, India.
Ann Card Anaesth. 2025 Apr 1;28(2):161-169. doi: 10.4103/aca.aca_218_24. Epub 2025 Apr 16.
Intraoperative quantification of mitral regurgitation (MR) is sometimes necessary to quantify the severity of incidentally detected MR during cardiac surgeries. We aimed to compare and correlate the regurgitant volume (Rvol) and regurgitant fraction (RF) using 2D proximal isovelocity surface area (PISA) and 3D vena contracta area (VCA) with the 3D volumetric method and the integrated multiparametric approach.
A prospective observational study was conducted on 37 patients undergoing mitral valve surgery for MR. Intraoperative quantification of the severity of MR was done using 2D PISA and 3D VCA methods and was compared with the 3D volumetric method. All three methods were compared with the integrated multiparametric method to obtain cutoff values for identifying severe MR.
The correlation coefficients for Rvol with VCA and PISA with the 3D volumetric method were 0.688 and 0.58, respectively. VCA and PISA overestimated the Rvol (VCA = 77.93 ± 27.82 ml, PISA = 76.13 ± 19.25 ml) compared to the 3D volumetric method (66.12 ± 20.30 ml); the RF by the three methods was comparable. Using the receiver operating characteristic-area under curve (AUC) comparing Rvol by these methods with the integrated multiparametric method, the 3D volumetric method performed the best.
The Rvol VCA and PISA overestimated MR severity compared to the 3D volumetric method with moderate to good correlation. Rvol 3D was superior with a higher AUC when compared with the integrated multiparametric approach. The RF by the three methods was comparable, albeit with a higher threshold in quantifying severity compared to the conventional criteria.
心脏手术中有时需要对二尖瓣反流（MR）进行术中定量，以评估偶然发现的MR的严重程度。我们旨在使用二维近端等速表面积（PISA）和三维瓣口收缩期面积（VCA），将反流容积（Rvol）和反流分数（RF）与三维容积法和综合多参数方法进行比较并建立相关性。
对37例因MR接受二尖瓣手术的患者进行了一项前瞻性观察研究。使用二维PISA和三维VCA方法对MR严重程度进行术中定量，并与三维容积法进行比较。将这三种方法与综合多参数方法进行比较，以获得识别严重MR的截断值。
Rvol与VCA以及PISA与三维容积法的相关系数分别为0.688和0.58。与三维容积法（66.12±20.30ml）相比，VCA和PISA高估了Rvol（VCA=77.93±27.82ml，PISA=76.13±19.25ml）；三种方法测得的RF相当。通过比较这些方法测得的Rvol与综合多参数方法的受试者工作特征曲线下面积（AUC），三维容积法表现最佳。
与三维容积法相比，Rvol、VCA和PISA高估了MR严重程度，相关性为中度至良好。与综合多参数方法相比，三维Rvol的AUC更高，表现更优。三种方法测得的RF相当，尽管在量化严重程度方面比传统标准有更高的阈值。
