| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Circulation. 1996;94:119-121.)
© 1996 American Heart Association, Inc.
Articles |
Noninvasive Quantification of Valvular Regurgitation
Getting to the Core of the Matter
the Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center (Dallas)
Correspondence to Paul A. Grayburn, MD, Division of Cardiology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75235-9047. E-mail grayburn@ryburn.swmed.edu.
Key Words: Editorials • echocardiography • magnetic resonance imaging • valves • regurgitation
 |
Introduction |
|---|
Initial attempts to quantify the severity of valvular regurgitation have been focused on imaging the regurgitant jet in the downstream chamber. Such methods, although intuitively appealing, are not based on solid physical principles and have not been proven to be accurate. Angiography, which for years was considered the gold standard, is invasive, only semiquantitative, and subject to a number of technical limitations.1 Likewise, subjective visual assessment of the downstream jet with the use of Doppler color flow mapping is semiquantitative at best and is affected by several hemodynamic and technical variables.2 3 4 5 Accordingly, a great deal of effort has centered on finding an accurate quantitative method of evaluating valvular regurgitation. Many of these efforts have been founded on sound physical principles but have been difficult to implement due to inherent weaknesses in the imaging methodology.
|
Conservation of Mass: The Continuity Equation |
|---|
The oldest principle used to quantify valvular regurgitation is the continuity equation, which is based on the principle of conservation of mass. According to the continuity equation, forward flow across each of the heart valves should be equal in the absence of an intracardiac shunt or valvular regurgitation. In the catheterization laboratory, left-sided valvular regurgitation is calculated as the difference between left ventriculographic stroke volume and forward stroke volume according to either the Fick or the thermodilution method.1 Unfortunately, angiographic stroke volumes may be affected by arrhythmias or failure to fully opacify the entire left ventricle due to improper catheter position or an insufficient amount of contrast agent. Furthermore, Fick outputs are less accurate at high
This article has been cited by other articles:
 |
|
 |
|
  J. Hung, J. Solis, J. L. Guerrero, G. J.C. Braithwaite, O. K. Muratoglu, M. Chaput, L. Fernandez-Friera, M. D. Handschumacher, V. J. Wedeen, S. Houser, et al. A Novel Approach for Reducing Ischemic Mitral Regurgitation by Injection of a Polymer to Reverse Remodel and Reposition Displaced Papillary Muscles Circulation, September 30, 2008; 118(14_suppl_1): S263 - S269. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Hung, M. Chaput, J. L. Guerrero, M. D. Handschumacher, L. Papakostas, S. Sullivan, J. Solis, and R. A. Levine Persistent Reduction of Ischemic Mitral Regurgitation by Papillary Muscle Repositioning: Structural Stabilization of the Papillary Muscle Ventricular Wall Complex Circulation, September 11, 2007; 116(11_suppl): I-259 - I-263. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Zamorano, L. P. de Isla, L. Oliveros, C. Almeria, J. L. Rodrigo, A. Aubele, J. Banchs, and C. Macaya Prognostic influence of mitral regurgitation prior to a first myocardial infarction Eur. Heart J., February 2, 2005; 26(4): 343 - 349. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Hung, J. L. Guerrero, M. D. Handschumacher, G. Supple, S. Sullivan, and R. A. Levine Reverse Ventricular Remodeling Reduces Ischemic Mitral Regurgitation: Echo-Guided Device Application in the Beating Heart Circulation, November 12, 2002; 106(20): 2594 - 2600. [Abstract] [Full Text] [PDF]
|
|