Circulation, Vol 83, 594-604, Copyright © 1991 by American Heart Association
F Recusani, GS Bargiggia, AP Yoganathan, A Raisaro, LM Valdes-Cruz, HW Sung, C Bertucci, M Gallati, VA Moises and IA Simpson
While color Doppler flow mapping has yielded a quick and relatively
sensitive method for visualizing the turbulent jets generated in valvular
insufficiency, quantification of the degree of valvular insufficiency has
been limited by the dependence of visualization of turbulent jets on
hemodynamic as well as instrument-related factors. Color Doppler flow
imaging, however, does have the capability of reliably showing the spatial
relations of laminar flows. An area where flow accelerates proximal to a
regurgitant orifice is commonly visualized on the left ventricular side of
a mitral regurgitant orifice, especially when imaging is performed with
high gain and a low pulse repetition frequency. This area of flow
convergence, where the flow stream narrows symmetrically, can be quantified
because velocity and the flow cross-sectional area change in inverse
proportion along streamlines centered at the orifice. In this study, a
gravity-driven constant-flow system with five sharp-edged diaphragm
orifices (ranging from 2.9 to 12 mm in diameter) was imaged both parallel
and perpendicular to the direction of flow through the orifice. Color
Doppler flow images were produced by zero shifting so that the abrupt
change in display color occurred at different velocities. This "aliasing
boundary" with a known velocity and a measurable radial distance from the
center of the orifice was used to determine an isovelocity hemisphere such
that flow rate through the orifice was calculated as 2 pi r2 x Vr, where r
is the radial distance from the center of the orifice to the color change
and Vr is the velocity at which the color change was noted. Using Vr values
from 54 to 14 cm/sec obtained with a 3.75-MHz transducer and from 75 to 18
cm/sec obtained with a 2.5-MHz transducer, we calculated flow rates and
found them to correlate with measured flow rates (r = 0.94-0.99). The slope
of the regression line was closest to unity when the lowest Vr and the
correspondingly largest r were used in the calculation. The flow rates
estimated from color Doppler flow imaging could also be used in conjunction
with continuous-wave Doppler measurements of the maximal velocity of flow
through the orifice to calculate orifice areas (r = 0.75-0.96 correlation
with measured areas).(ABSTRACT TRUNCATED AT 250 WORDS)
ARTICLES
A new method for quantification of regurgitant flow rate using color Doppler flow imaging of the flow convergence region proximal to a discrete orifice. An in vitro study
I.R.C.C.S. Policlinico San Matteo, Universita degli Studi di Pavia, Italy.
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