Three-Dimensional Transesophageal Echocardiographic Vena Contracta Area for Grading Mitral Regurgitation: Severity Cut-offs From a Prospective Tunisian Cohort.

BACKGROUND: Mitral regurgitation (MR) is among the most common valvular heart diseases, but its echocardiographic quantification remains challenging, particularly in secondary MR and in some organic causes. Three-dimensional vena contracta area (3D VCA) allows direct planimetry of the regurgitant orifice. We aim to compare 3D VCA with two-dimensional (2D) parameters and to derive aetiology-specific severity cut-offs in a Tunisian cohort. METHODS: Prospective cross-sectional study. Patients with at least moderate MR underwent transthoracic and 2D/3D transesophageal echocardiography with planimetry of the VCA. Spearman correlations between 3D VCA and 2D parameters (vena contracta width, PISA-derived regurgitant orifice area), and diagnostic performance for severe MR (ROC, Youden index), were analyzed. RESULTS: Ninety-seven patients were included (mean age 61.6 ± 12.5 years; sex ratio 1.1). MR was primary in 66% (rheumatic 34%, degenerative 31%) and secondary in 34%; jets were mostly single, eccentric and holosystolic, and 62.9% had severe MR. 3D VCA correlated strongly with PISA-derived orifice area (rho = 0.78) and with vena contracta width (rho = 0.65), particularly in organic, rheumatic, degenerative and eccentric MR. 3D VCA and 2D orifice area identified severe MR with an area under the curve of 0.93; the optimal 3D VCA cut-off was 0.43 cm2 overall, 0.42 cm2 (rheumatic), 0.55 cm2 (degenerative) and 0.39 cm2 (secondary). CONCLUSION: 3D VCA reliably quantifies MR, provides aetiology-specific cut-offs and outperforms 2D methods in complex jets. Multicenter validation is needed, particularly in rheumatic-endemic regions.