(Circulation. 1995;92:2169-2177.)
© 1995 American Heart Association, Inc.
Articles |
Quantification of Mitral Regurgitation by the Proximal Convergence Method Using Transesophageal Echocardiography
Clinical Validation of a Geometric Correction for Proximal Flow Constraint
Presented in part at the 66th Scientific Sessions of the American Heart Association, Atlanta, Ga, November 7-11, 1993.
From the Cardiovascular Imaging Center and the Departments of Cardiology and Cardiothoracic Surgery (D.M.C.), Cleveland (Ohio) Clinic Foundation.
Correspondence to James D. Thomas, MD, FACC, Department of Cardiology, Desk F15, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44195-5064. E-mail thomasj@ccsmtp.ccf.org.
Background Proximal flow convergence is a promising method to quantify mitral regurgitation but may overestimate flow when the flow field is constrained. This has not been investigated clinically, nor has a correction factor been validated.
Methods and Results Eighty-five patients were studied
intraoperatively with transesophageal
echocardiography and divided into two groups:
central convergence (no constraining wall) and eccentric convergence
(at least one constraining wall). Regurgitant stroke volume (RSV) and
orifice area (ROA) were calculated by ROA=2
r2
Va/Vp and RSV=ROAxVTIcw, where
r and va are the radius and velocity of the aliasing
contour and vp and VTIcw are the peak and
integral of regurgitant velocity. In eccentric convergence patients,
convergence angle (
) was measured from two-dimensional
Doppler color flow maps, and ROA and RSV were corrected by
multiplying by /180. For reference, RSV was the difference between
thermodilution and pulsed Doppler stroke volumes. In central
convergence patients (n=45), RSV (r=.95, 
=2.5±10.8 mL)
and ROA (r=.96, =0.02±0.08 cm2) were
accurately calculated, but significant overestimation was noted in the
eccentric convergence patients (n=40, RSV=63.9±38.0 mL,
ROA=0.54±0.31 cm2), 68% of whom had leaflet prolapse
or flail. RSV was correlated with (r=–.69,
P<.001). After correction by /180, overestimation was
largely eliminated (RSV=15.5±19.3 mL and ROA=0.14±0.14
cm2) with excellent correlation for the whole group (RSV,
r=.91; ROA, r=.95).
Conclusions A simple geometric correction factor largely eliminates overestimation caused by flow constraint with the proximal convergence method and should extend the clinical utility of this technique.
Key Words: regurgitation • echocardiography • mitral valve • valves • hemodynamics
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