Circulation, Vol 88, 1150-1156, Copyright © 1993 by American Heart Association
PM Vandervoort, JM Rivera, D Mele, IF Palacios, RE Dinsmore, AE Weyman, RA Levine and JD Thomas
BACKGROUND. Analogous to stenotic valve area in the assessment of valvular
stenosis, regurgitant orifice area (ROA) represents a fundamental parameter
to assess valvular insufficiency. However, this parameter has not been
routinely available up to now. In this study, we introduce the concept and
provide the methodology to calculate regurgitant orifice area
noninvasively, based on the analysis of the proximal flow convergence zone.
METHODS AND RESULTS. In an in vitro study, we showed the feasibility and
the accuracy of calculating effective ROA by the proximal flow convergence
method throughout a range of driving pressures. The calculated and true ROA
showed an excellent correlation with r = .992, delta ROA = -1.4 +/- 2.9
mm2. We then applied this concept clinically in 77 patients with mitral
regurgitation and showed a very good correlation between effective ROA
calculated by the proximal flow convergence method and calculated by the
Doppler echocardiographic method: r = .95, delta ROA = -0.2 +/- 3.9 mm2.
The ROA also correlated very well with Doppler echocardiographic- derived
regurgitant stroke volume (r = .93) and regurgitant fraction (r = .82). In
a subgroup of 20 patients who underwent invasive evaluation, the calculated
effective ROA also correlated well with the angiographic grade of mitral
regurgitation (rho = .81). CONCLUSIONS. We conclude that effective ROA
represents unique information on the severity of a regurgitant lesion and
can easily be calculated by the proximal flow convergence method. This new
parameter should enhance our understanding and improve the serial
assessment of valvular regurgitation.
ARTICLES
Application of color Doppler flow mapping to calculate effective regurgitant orifice area. An in vitro study and initial clinical observations
Department of Cardiology, Cleveland Clinic Foundation, OH 44195.
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