Should mitral valve area assessment in patients with mitral stenosis be based on anatomical or on functional evaluation? A plea for 3D echocardiography as the new clinical standard

This editorial refers to "Non-invasive assessment of mitral valve area during percutaneous balloon mitral valvuloplasty: role of real-time 3D echocardiography" † by J. Zamorano et al. on page 2086 In the last decade, 3D echocardiography has evolved from a research tool to clinical utility in several cardiac applications. One of these is the accurate planimetry of native stenotic mitral1–7 and aortic8 valves and even mechanical prosthetic valves, both in the mitral and aortic position.9 Percutaneous mitral valvuloplasty (PMV) has become the procedure of choice for treatment of selected patients with mitral stenosis with favourable mitral valve anatomy, as mentioned by Zamorano et al. in this issue of the Journal .10 Although the Gorlin-derived mitral valve area (MVA) has been used before and after PMV, echocardiography is of paramount importance in assessing the indication before this procedure, as well as the success and possible complications afterwards.1,5 Until recently, MVA was assessed indirectly by the pressure half-time method,1–7 or by direct planimetry, by 2D transthoracic echocardiography,2–4,6,7 by 3D transthoracic echocardiography2,3,6,7 or by 3D transoesophageal echocardiography (TEE).1,3–5 All these methods have their advantages … *Correspondence to: Dr. Herman FJ Mannaerts, Department of Cardiology, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands. Tel.: +31 204442244; fax: +31 204442446 (E-mail: hfj.mannaerts{at}vumc.nl).