Circulation, Vol 83, 213-223, Copyright © 1991 by American Heart Association
ER Chafizadeh and WA Zoghbi
To test whether the continuity equation can be applied to the noninvasive
assessment of prosthetic aortic valve function, Doppler echocardiography
was performed in 67 patients (mean age, 58 +/- 14 years) within 10 +/- 6
days after valve replacement with St. Jude Medical valves. All patients
were clinically stable and without evidence of valve dysfunction. Valve
size ranged from 19 to 31 mm, and ejection fraction ranged from 30% to 75%.
With the parasternal long- axis view, the left ventricular outflow diameter
measured just proximal to the prosthetic valve correlated well with valve
size (r = 0.92). Doppler-derived maximal gradients ranged from 9 to 71 mm
Hg. Effective prosthetic aortic valve area by the continuity equation
ranged between 0.73 cm2 for a 19-mm valve and 4.23 cm2 for a 31-mm valve.
With analysis of variance, effective orifice area differentiated various
valve sizes (p less than 10(-14)) better than did gradients alone (p =
0.003) and correlated better with actual valve orifice area (r = 0.83
versus - 0.40). A Doppler velocity index, the ratio of peak velocity in the
left ventricular outflow to that of the aortic jet, averaged 0.41 +/- 0.09
and was less dependent on valve size (r = 0.43). Thus, the continuity
equation can be applied to the assessment of prosthetic St. Jude valves in
the aortic position. By accounting for flow through the valve, it provides
an improved assessment over the sole use of gradients in the evaluation of
prosthetic valve function.
ARTICLES
Doppler echocardiographic assessment of the St. Jude Medical prosthetic valve in the aortic position using the continuity equation
Department of Medicine, Baylor College of Medicine, Houston, Tex.
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