Circulation, Vol 84, 712-720, Copyright © 1991 by American Heart Association
CG Chen, JD Thomas, J Anconina, P Harrigan, L Mueller, MH Picard, RA Levine and AE Weyman
BACKGROUND. In clinical color Doppler examinations, mitral regurgitant jets
are often observed to impinge on the left atrial wall immediately beyond
the mitral valve. In accordance with fluid dynamics theory, we hypothesized
that a jet impinging on a wall would lose momentum more rapidly, undergo
spatial distortion, and thus have a different observed jet area from that
of a free jet with an identical flow rate. METHODS AND RESULTS. To test
this hypothesis in vivo, we studied 44 patients with mitral
regurgitation--30 with centrally directed free jets and 14 with
eccentrically directed impinging wall jets. Maximal color jet areas (cm2)
(with and without correction for left atrial size) were correlated with
mitral regurgitant volumes, flow rates, and fractions derived from pulsed
Doppler mitral and aortic forward flows. The groups were compared by
analysis of covariance. Mean +/- SD mitral regurgitant fraction,
regurgitant volume, and mean flow rate averaged 37 +/- 17%, 3.06 +/- 2.65
l/min, and 147 +/- 118 ml/sec, respectively. The maximal jet area from
color Doppler imaging correlated relatively well with the mitral
regurgitant fraction in the patients with free mitral regurgitant jets (r =
0.74, p less than 0.0001) but poorly in the patients with impinging wall
jets (r = 0.42, p = NS). Although the mitral regurgitant fraction was
larger (p less than 0.05) in patients with wall jets (44 +/- 20%) than in
those with free jets (33 +/- 15%), the maximal jet area was significantly
smaller (4.78 +/- 2.87 cm2 for wall jets versus 9.17 +/- 6.45 cm2 for free
jets, p less than 0.01). For the same regurgitant fraction, wall jets were
only approximately 40% of the size of a corresponding free jet, a
difference confirmed by analysis of covariance (p less than 0.0001).
CONCLUSIONS. Patients with mitral regurgitation frequently have jets that
impinge on the left atrial wall close to the mitral valve. Such impinging
wall jets are less predictable and usually have much smaller color Doppler
areas in conventional echocardiographic views than do free jets of similar
regurgitant severity. Jet morphology should be considered in the
semiquantitative interpretation of mitral regurgitation by Doppler color
flow mapping. Future studies of the three-dimensional morphology of wall
jets may aid in their assessment.
ARTICLES
Impact of impinging wall jet on color Doppler quantification of mitral regurgitation
Noninvasive Cardiac Laboratories, Massachusetts General Hospital, Boston 02114.
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