3D vena contracta area to quantify severity of mitral regurgitation: a practical new tool?

M itral regurgitation (MR) is a common form of valvular disease1 and its severity is associated with excess morbidity and mortality from left ventricular (LV) remodeling, left atrial remodeling, pulmonary pressure elevation, and progression to left and right heart failure.2-6 Current American Society of Echocardiography (ASE) Guidelines7 propose vena contracta (VC) width as a simple semi-quantitative marker of MR severity. The VC width is defined as the minimal color Doppler diameter at the junction of the flow convergence acceleration zone and the turbulent regurgitant jet just distal to the regurgitant orifice (Figure 1). One limitation of this simple measure is that the VC width is only a single tomographic slice of a three-dimensional flow event. Three-dimensional vena contracta area (3D-VC area) is a novel measurement made possible by 3D color Doppler imaging. Here we review the methodology and clinical validation of this new measurement tool for the quantification of MR severity.