Circulation, Vol 85, 1565-1571, Copyright © 1992 by American Heart Association
ES Caguioa, SC Reimold, S Velez and RT Lee
BACKGROUND. The regurgitant volume in aortic regurgitation is determined by
the diastolic filling period, the pressure gradient between the left
ventricle and aorta, and the hemodynamic size of the regurgitant orifice
area. METHODS AND RESULTS. To test the hypothesis that the aortic
regurgitant orifice area is related to aortic pressure and aortic root
size, 16 fresh calf heart and aorta specimens were studied in vitro using a
continuous-flow system over a range of aortic pressures. Regurgitant
orifice areas were calculated as the ratio of flow divided by peak velocity
through the valve measured by image- guided continuous-wave Doppler, and
aortic root areas were measured by two-dimensional echocardiography. When
the defect was created at the edge of the noncoronary leaflet (n = 10),
regurgitant orifice area gradually increased 51 +/- 33% when aortic
pressure was increased from approximately 40 to 152 cm of water (29.6 to
112.5 mm Hg) (p less than 0.0001). Similarly, the aortic root size
increased 82 +/- 29% when the defect was created at the leaflet edge (p
less than 0.0001). In contrast, when defects were created at the center of
the noncoronary leaflet (n = 6), only a small increase in regurgitant
orifice area (9 +/- 7%) was observed with increasing pressure (p = 0.043).
The aortic root area remained strongly pressure dependent in specimens with
defects at leaflet centers (p less than 0.0001). CONCLUSIONS. The aortic
regurgitant orifice area is dependent on both aortic pressure and the
nature of the defect in the valve. Because not all regurgitant aortic
valves are alike, further study of the nature of the regurgitant orifice
area in humans may allow identification of patients who would benefit most
from aggressive pharmacological therapy.
ARTICLES
Influence of aortic pressure on effective regurgitant orifice area in aortic regurgitation
Department of Medicine, Brigham and Women's Hospital, Boston, Mass. 02115.
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