Circulation, Vol 51, 88-97, Copyright © 1975 by American Heart Association
GM Pohost, RE Dinsmore, JJ Rubenstein, DD O'Keefe, RN Grantham, HE Scully, EA Beierholm, JW Frederiksen, ML Weisfeldt and WM Daggett
The echocardiogram of the anterior leaflet of the mitral valve (ECHO) was
compared to hemodynamic and cineroentgenographic data to evaluate its
accuracy in timing mitral valve (MV) opening and closure, and to validate
it as an indicator of MV motion. The ECHO, high speed cineroentgenography
at 250 frames/sec, and/or measurement of intracardiac pressures allowed
accurate timing of the events of MV motion in dogs on right heart bypass.
The intersection of left ventricular and left atrial pressures in early
diastole preceded the onset of rapid anterior motion of ECHO (D' point) by
17 to 33 plus or minus 7.6 msec; r equals 0.98. The onset of left
ventricular systole occurred before the termination of final rapid
posterior motion of the ECHO in end diastole (Co point) by 25 plus or minus
10 msec; r equals 0.96. Radiopaque clips were attached to the free edges of
both leaflets of the MV. Cineroentgenographically determined plots of clip
distance from the ultrasound transducer were morphologically similar to the
simultaneously recorded ECHO. A delay of 23 plus or minus 3 (0 to 40) msec
was observed in the ECHO peaks of diastolic anterior excursion compared to
clip motion. Contrast medium advances beyond the free edges of MV leaflets
mixing with left ventricular blood 43 plus or minus 3 msec after initial
separation. These cineroentgenographic studies elucidate nonuniformity of
leaflet motion responsible for ECHO delays. Thus, ECHO D' and Co correlate
well with hemodynamic indicators of MV opening and closure. However, ECHO
motion, although qualitatively similar, is unpredictably delayed compared
to cineroentgenography of clips on the MV free edge. Since the ECHO
correlates well with hemodynamic indices of MV opening and closure, this
noninvasive technique can be used as a reference in the timing of
intracardiac events and in the determination of systolic and diastolic time
intervals.
ARTICLES
The echocardiogram of the anterior leaflet of the mitral valve. Correlation with hemodynamic and cineroentgenographic studies in dogs
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