Diagnostic Value of 3D Transesophageal Vena Contracta Area versus 2D Echocardiographic Assessment of Secondary Mitral Regurgitation

Abstract

ABSTRACT Background Secondary mitral regurgitation (MR) is associated with substantial cardiovascular morbidity and mortality, making accurate severity assessment essential for clinical management. Conventional 2D echocardiography has important limitations, particularly in the presence of noncircular regurgitant orifices. Three‐dimensional transesophageal echocardiography (3D‐TEE) enables direct measurement of Vena Contracta area (VCA) and may provide more accurate quantification of MR severity. Aim of the work To assess the diagnostic value of three‐dimensional transesophageal Vena Contracta area versus two‐dimensional echocardiographic assessment of secondary mitral regurgitation. Methods This study included 52 patients with moderate‐to‐severe secondary MR, recruited at Alzahraa University Hospital between December 2024 and January 2026. All patients underwent TTE followed by TEE. MR severity was assessed according to current echocardiographic guidelines using an integrative approach that included qualitative, semi‐quantitative, and quantitative assessments. Three‐dimensional VCA was measured by both TTE and TEE using multiplanar reconstruction. Statistical analysis was performed using Jamovi version 2.3.28 for Windows, with P ‐values < 0.05 considered statistically significant. Results The mean age of the patients studied was 58.08 ± 9.52 years, with a male‐to‐female ratio of 43:9. The mean PISA‐derived EROA for patients with severe MR was 0.36 ± 0.09 cm 2 , and the mean regurgitant volume for these patients was 48.6 ± 6.79 mL. VCA measured by 3D TTE (0.69 ± 0.16 cm 2 ) showed a strong positive correlation with 3D TEE VCA (0.67 ± 0.16 cm 2 ) ( r = 0.857, p < 0.001). Bland–Altman analysis demonstrated minimal bias (0.035 cm 2 ) and good agreement between both techniques. ROC analysis showed good diagnostic accuracy for severe MR, with slightly higher accuracy for TEE VCA (AUC = 0.874) compared with TTE VCA (AUC = 0.841). Conclusion Three‐dimensional TEE‐derived Vena Contracta area (3D TEE VCA) is a reliable and accurate method for assessing the severity of secondary mitral regurgitation. The strong correlation and good agreement between 3D TEE and 3D TTE VCA measurements, as well as their correlation with PISA‐derived EROA, support the value of 3D VCA as a robust quantitative parameter. Moreover, our findings suggest that 3D TTE VCA may represent a feasible, less invasive alternative in selected patients; however, its use as a replacement for TEE warrants confirmation in larger multicenter studies with external validation. Larger multicenter studies with external validation are required before it can be considered a replacement for TEE.