Figure Legends
Figure 1. Biplane Mode (X-plane) acquisition with 3D transoesophageal echocardiography. Left side
panel: reference plane mid-oesophageal 4 chamber view. Right side panel: 2D image of the mitral
valve from a plane rotated 95⁰ from the reference plane. AML- anterior mitral leaflet; PML –
posterior mitral leaflet.
Figure 2. 3D Zoom acquisition of the mitral valve as seen from the atrial perspective by 3D
transoesophageal echocardiography. The images is then rotated in such a way that the aorta is
located anteriorly (flipped image indicated by arrow). Ao –aorta.
Figure 3. Full Volume Gated Acquisition with 3D transoesophageal echocardiography. Acquisition is
done over 4 cardiac cycles that enables a good temporal resolution (32 volumes per second).
Figure 4. Full Volume Color Flow Doppler acquisition with 3D transthoracic echocardiography. The
full volume color Doppler is reconstructed by stitching together 4 narrow pyramidal sets. Off line
analysis enables evaluation of vena contracta area by direct planimetry.
Figure 5. 3D transthoracic echocardiography evaluation in a patient with dilated cardiomyopathy
and secondary mitral regurgitation. Apical systolic displacement of the mitral valve leaflets
coaptation point as seen from a lateral aspect (Panel A, yellow arrow, the blue dotted line
represents the mitral annulus plane). Apical and lateral displacement of the papillary muscles
exerting a tethering effect on the mitral leaflets in mid-systole as seen from the ventricular view
(Panel B, yellow arrows). For rapid recognition of the anatomic landmarks the ventricular aspect of
the mitral valve apparatus is also shown in diastole (Panel C). Funnel shape morphology of the mitral
valve as seen from the atrial perspective in the same patient (Surgeon’s view, Panel D). All images
are reconstructed from the same 3D pyramidal data set. AML- anterior mitral leaflet; PML- posterior
mitral leaflet; Ao- aorta.
Figure 6. Surgeon’s view of the mitral valve in a patient with secondary mitral regurgitation (SMR)
and idiopathic dilated cardiomyopathy showing the funnel shape of the mitral valve as seen from the
atrial perspective (3D transthoracic echocardiography, Panel A). The chosen frame is in mid-systole,
tethering on the MV leaflets being maximal (Panel A, yellow arrow indicating mid-systole on the ECG
tracing). For easy recognition of the anatomic landmarks the valve is also shown in diastole (Panel B).
Ao-aorta; ALC –anterolateral commissure; PMC – posteromedial commissure.
Figure 7. Mitral annular reconstruction from 3D transoesopageal datasets with measurement of the
antero-posterior diameter of the mitral annulus (green continuous line).
Figure 8. Mitral valve morphology reconstruction from 3D transoesopageal datasets with
measurement of the mitral valve tenting volume and height, intercommissural diameter and
anterior and posterior leaflet area.
Figure 9. 2D transthoracic evaluation from the parasternal short axis view at the level of the mitral
valve in a patient with secondary mitral regurgitation (SMR) showing the elliptical shape of the vena
contracta (VC) of the regurgitant jet (green dotted line). Measurement of VC from the parasternal
long axis view (PSLA) would underestimate the severity of the MR (white line) while measurement
from the 2-chamber view (2-Ch) would overestimate its severity (black arrow). PSLA- parasternal
long axis view; 2-Ch – 2 chamber view.
Figure 10. Vena contracta (VC) area measurement by 3D transthoracic echocardiography in a patient
with secondary mitral regurgitation and dilated cardiomyopathy. After full volume color Doppler
acquisition with the 3D transthoracic probe from the apical window the 3D data set is cropped to
derive the area of the vena contracta of the regurgitant jet. Direct planimetry of the vena contracta
area is possible (white line enclosed area). The dotted green line represents the orthogonal plane in
which the VC area measurement was done.
Figure 11. Instantaneous “Full volume” 3D transthoracic echocardiography with the assessment of
the effective regurgitant orifice (ERO) area and regurgitant volume of a secondary mitral
regurgitation by direct 3D measurement of proximal isovelocity surface area.