(Circulation. 1995;92:2951-2958.)
© 1995 American Heart Association, Inc.
Articles |
Changes in Effective Regurgitant Orifice Throughout Systole in Patients With Mitral Valve Prolapse
A Clinical Study Using the Proximal Isovelocity Surface Area Method
From the Division of Cardiovascular Diseases and Internal Medicine (M.E.-S., L.J.S., A.J.T., J.B.S.) and the Section of Biostatistics (K.R.B.), Mayo Clinic and Mayo Foundation, Rochester, Minn.
Background In patients with mitral valve prolapse, spontaneous changes of the effective regurgitant orifice during systole are not well documented. Such changes can now be analyzed by use of the proximal isovelocity surface area method, but the changes raise concern about the reliability of this method for assessing overall severity of regurgitation in these patients.
Methods and Results In a prospective study of 42 patients with mitral valve prolapse, the effective mitral regurgitant orifice was calculated at four phases of systole (early, mid, mid-late, and late) as the ratio of regurgitant flow to regurgitant velocity by use of the proximal isovelocity surface area method. Throughout systole, the effective regurgitant orifice increased significantly, from 32±27 mm2 in early systole to 41±27 in midsystole, 55±30 in mid-late systole, and 107±66 mm2 during late systole (P<.0001). Phasic regurgitant volume increased from early to mid-late systole but decreased in late systole. For quantitation of the overall effective regurgitant orifice, four approaches using the proximal isovelocity surface area were compared with simultaneously performed quantitative Doppler echocardiography (54±30 mm2) and quantitative two-dimensional echocardiography (51±29 mm2). All correlations were good (r>.95), but overestimation was considerable when the largest flow convergence was used (70±39 mm2; both P<.0001), significant when the simple mean of the four phases was used (59±36 mm2; P=.005 and P=.0007, respectively), mild when a weighted mean of the four phases was used (55±33 mm2; P=.41 and P=.01, respectively), and no overestimation was observed when the effective regurgitant orifice calculated at maximum regurgitant velocity was used (54±30 mm2; P=.29 and P=.17, respectively).
Conclusions Phasic changes of mitral regurgitation are observed in patients with mitral valve prolapse. The effective regurgitant orifice increases throughout systole. Regurgitant volume also increases initially but tends to decrease in late systole. These changes can lead to overestimation of the overall degree of regurgitation, but properly timed measurements made by use of the proximal isovelocity surface area method allow an accurate estimation of the overall effective regurgitant orifice.
Key Words: echocardiography • regurgitation • mitral valve • valves
This article has been cited by other articles:
 |
|
 |
|
  R. A.H. Stewart, O. C. Raffel, A. J. Kerr, R. Gabriel, I. Zeng, A. A. Young, and B. R. Cowan Pilot Study to Assess the Influence of {beta}-Blockade on Mitral Regurgitant Volume and Left Ventricular Work in Degenerative Mitral Valve Disease Circulation, September 2, 2008; 118(10): 1041 - 1046. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Enriquez-Sarano, V. T. Nkomo, and H. Michelena Principles and Practice of Echocardiography in Cardiac Surgery Card. Surg. Adult, January 1, 2008; 3(2008): 315 - 348. [Full Text]
|
|
|
|
 |
|
 D. Messika-Zeitoun, S. Fung Yiu, B. Cormier, B. Iung, C. Scott, A. Vahanian, A Jamil Tajik, and M. Enriquez-Sarano Sequential assessment of mitral valve area during diastole using colour M-mode flow convergence analysis: new insights into mitral stenosis physiology Eur. Heart J., July 1, 2003; 24(13): 1244 - 1253. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Sitges, M. Jones, T. Shiota, D. L. Prior, J. X. Qin, H. Tsujino, F. Bauer, Y. J. Kim, D. Deserranno, N. L. Greenberg, et al. Interaliasing distance of the flow convergence surface for determining mitral regurgitant volume: a validation study in a chronic animal model J. Am. Coll. Cardiol., October 1, 2001; 38(4): 1195 - 1202. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Enriquez-Sarano, A.-J. Basmadjian, A. Rossi, K. R. Bailey, J. B. Seward, and A. J. Tajik Progression of mitral regurgitation: A prospective Doppler echocardiographic study J. Am. Coll. Cardiol., October 1, 1999; 34(4): 1137 - 1144. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Hung, Y. Otsuji, M. D. Handschumacher, E. Schwammenthal, and R. A. Levine Mechanism of dynamic regurgitant orifice area variation in functional mitral regurgitation: Physiologic insights from the proximal flow convergence technique J. Am. Coll. Cardiol., February 1, 1999; 33(2): 538 - 545. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. B. Rosario, L. W. Stevenson, S. D. Solomon, R. T. Lee, and S. C. Reimold The mechanism of decrease in dynamic mitral regurgitation during heart failure treatment: importance of reduction in the regurgitant orifice size J. Am. Coll. Cardiol., December 1, 1998; 32(7): 1819 - 1824. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. M. Tribouilloy, M. Enriquez-Sarano, S. L. Fett, K. R. Bailey, J. B. Seward, and A. J. Tajik Application of the proximal flow convergence method to calculate the effective regurgitant orifice area in aortic regurgitation J. Am. Coll. Cardiol., October 1, 1998; 32(4): 1032 - 1039. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. S. Dujardin, M. Enriquez-Sarano, K. R. Bailey, R. A. Nishimura, J. B. Seward, and A. J. Tajik Grading of Mitral Regurgitation by Quantitative Doppler Echocardiography : Calibration by Left Ventricular Angiography in Routine Clinical Practice Circulation, November 18, 1997; 96(10): 3409 - 3415. [Abstract] [Full Text]
|
|