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Background: Quantitative analysis of mitral valve (MV) can discriminate among various mechanisms causing valve insufficiency. There are no established reference values for MV geometry, nor data on its feasibility and reproducibility with latest transthoracic 3D echocardiography (3DTTE). Methods: Eighty-one consecutive healthy volunteers (43+13 years, range 18-70; 33 men) with good apical window underwent a 3D full-volume acquisition of MV apparatus (32+2 vps) using Vivid E9 (BT 12, GE Healthcare, Horten, N). MV datasets were analyzed offline using a software recently developed for 3DTTE (TomTec MV assessment 2.0, Unterschleissheim, D). Intra- and inter-observer reproducibility were assessed in 15 subjects and expressed as intraclass correlation coefficients (ICC). Results: Five subjects were excluded due to low quality of 3D dataset with poor MV tracking (feasibility 94%). The average analysis time of one dataset (including manual editing) was 2’. Reference values of MV parameters and their reproducibility are reported in Table. Leaflet tenting and annulus measures were positively correlated with body surface area (BSA, r=0.34-0.53, p , 0.001), but not with age. After correcting for BSA, there were no gender differences in MV parameters. Conclusion: Quantitative analysis of MV by 3DTTE is highly feasible and reproducible, and reference values are reported. Our findings may support the implementation of MV quantitative analysis by 3DTTE in clinical settings.

Quantification of cardiac chambers size, geometry and function represent the most frequent indications for an echocardiographic study and are pivotal for patient evaluation and management. Three-dimensional echocardiography (3DE) enables an easier, more accurate and reproducible interpretation of the complex geometry of cardiac chambers, overcoming the intrinsic limitations of conventional two-dimensional echocardiography (2DE). One major advantage of the third dimension is the improvement in the accuracy and reproducibility of chamber volume measurement by eliminating geometric assumptions and errors caused by foreshortened views. This feature render the technique feasible and reliable even in patients with asymmetric or distorted cardiac chambers, paradoxically the subjects in whom an accurate quantification is most needed. The purpose of this review is to analyze the role of 3DE in chamber quantification, emphasizing the incremental benefits of 3DE over conventional 2DE.

Integrating volumetric rendering with motion in real-time, three-dimensional (3D) echocardiography is the most suitable imaging technique for assessing heart valves. Today, the rapidly advancing 3D technology allows us to perform a virtual 'dissection' of the heart intra vitam and to discover unprecedented, realistic views of cardiac valves in just a few minutes. The mitral valve is the cardiac structure easiest to visualize by transthoracic or transoesophageal approach. Three-dimensional echocardiography is able to display the non-planar valve leaflets and annulus, the complex subvalvular apparatus and their spatial relationships with the surrounding structures. The complementary use of 3D colour flow adds data about valve integrity and allows the quantitation of valvular diseases. Accumulating evidence suggests that 3D echocardiography is emerging as the reference technique to assess mitral valve morphology and function and guide valvular procedures of mounting complexity. The purpose of this review is to provide an update on the current clinical applications of 3D echocardiography for assessing mitral valves and to stress the incremental benefits of 3D echocardiography over conventional two-dimensional echocardiography.