(Circulation. 1997;95:548-550.)
© 1997 American Heart Association, Inc.
Articles |
How Leaky Is That Mitral Valve?
Simplified Doppler Methods to Measure Regurgitant Orifice Area
the Cardiovascular Imaging Center, Department of Cardiology, Cleveland (Ohio) Clinic Foundation.
Correspondence to James D. Thomas, MD, Department of Cardiology, F-15, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44195. E-mail thomasj@cesmtp.ccf.org.
Key Words: mitral valve • regurgitation • echocardiography • hemodynamics • Editorials
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Introduction |
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Twenty years ago there was limited need for precise quantification of mitral regurgitation (MR). With valve replacement the only surgical option, leading cardiologists recommended that intervention be "considered only for patients who are in functional classes III and IV and do not respond to medical management,"1 even though that strategy was associated with a 20% in-hospital mortality rate2 and often led to severe postoperative left ventricular failure. With the improvement and widespread availability of valve repair surgery, cardiologists have been encouraged to refer patients for intervention earlier in the course of their disease,3 reflecting the low risk for this procedure (0% mortality in 595 primary, isolated mitral valve repairs over the past 4 years at the Cleveland Clinic). Today, patients may be operated on while still completely asymptomatic, with the magnitude of MR and the appearance of occult left ventricular dysfunction4 being the principal events triggering intervention. Thus, it is of paramount importance that MR be quantified accurately over time so that surgery may be timed appropriately.
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`Eyeball' Methods |
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Unfortunately, although a host of quantitative techniques derived from echocardiographic, angiographic, nuclear, and magnetic resonance data are available to characterize the severity of regurgitation, in routine clinical practice these are applied with surprising inconsistency. For the most part, regurgitation is assessed by the "eyeball" method, whereby an observer grades, in a categorical, semiquantitative sense, some imaging modality, typically color Doppler echocardiography5 or contrast ventriculography,6 and arrives at an interpretation of the MR as mild, moderate, or severe. For many clinical applications, this approach
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