Application of color doppler flow mapping to calculate effective regurgitant orifice area: An in vitro study and initial clinical observations

Pieter M. Vandervoort*, J. Miguel Rivera, Donato Mele, Igor F. Palacios, Robert E. Dinsmore, Arthur E. Weyman, Robert A. Levine, James D. Thomas

*Corresponding author for this work

Research output: Contribution to journalArticle

170 Scopus citations

Abstract

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, ΔROA=-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, ΔROA=-0.2±3.9 mm2. The ROA also correlated very well with Doppler echocardiographic-derived régurgitant 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 (ρ=.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.

Original languageEnglish (US)
Pages (from-to)1150-1156
Number of pages7
JournalCirculation
Volume88
Issue number3
DOIs
StatePublished - Sep 1993

Keywords

  • Doppler
  • Echocardiography
  • Valvular regurgitation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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