Use of the three-dimensional technique to remove the looking glass through which the echocardiographers have imagined the pathophysiology of atrioventricular valve regurgitation

This editorial refers to ‘Differences in mitral valve geometry between atrial and ventricular functional mitral regurgitation in patients with atrial fibrillation: a three-dimensional transesoèhageal echocardiography study’ by G. Uno et al., pp. 1106--16. Historically, echocardiography has always represented the mainstay of assessing the pathophysiology of atrioventricular valve diseases, their severity, and the extent of their impact on the up- and down-stream cardiac chambers.1 However, both the need of geometric assumptions and the limited visualization of the actual anatomy of the various components of the valve structures inherent to the 2D technique have hampered our ability to understand the various mechanisms leading to functional regurgitation of the atrioventricular valves. These limitations have brought to the oversimplification of these mechanisms, and the functional regurgitation of the atrioventricular valves has grossly been attributed to the dilatation of the annuli secondary to both the remodelling and dysfunction of the ventricles.2 The...