Circulation, Vol 82, 1467-1475, Copyright © 1990 by American Heart Association
H Baumgartner, S Khan, M DeRobertis, L Czer and G Maurer
To evaluate possible causes of discrepancy between Doppler and catheter
gradients across prosthetic valves, five sizes (19-27 mm) of St. Jude and
Hancock valves were studied in an aortic pulsatile flow model. Catheter
gradients at multiple sites distal to the valve were compared with
simultaneously obtained Doppler gradients. In the St. Jude valve,
significant differences between Doppler and catheter gradients measured 30
mm downstream from the valve were found: Doppler gradients exceeded peak
catheter gradients of 10 mm Hg or more by 81 +/- 35% (15 +/- 3.6 mm Hg),
and mean catheter gradients by 71 +/- 11% (10.3 +/- 2.5 mm Hg). When the
catheter was pulled back through the tunnel-like central orifice of the
valve, high localized gradients at the valve plane and significant early
pressure recovery were found. When the catheter was pulled back through the
large side orifices, gradients at the same level were only 46 +/- 6% of the
central orifice gradients (mean difference, 7.6 +/- 4.5 mm Hg). Doppler
peak and mean gradients showed excellent agreement with the highest central
orifice catheter gradients (mean difference, 1.0 +/- 3.1 and 0.9 +/- 1.5 mm
Hg, respectively). A significantly better agreement between Doppler and
catheter gradients at 30 mm was found for the Hancock valve, although
Doppler peak and mean gradients were still slightly greater than catheter
gradients. Doppler gradients exceeded catheter gradients by 18 +/- 10% (3.4
+/- 1.9 mm Hg) and 13 +/- 11% (2.1 +/- 0.9 mm Hg), respectively. When the
catheter was pulled back through the valve, the highest gradients were
found approximately 20 mm distal to the valve ring.(ABSTRACT TRUNCATED AT
250 WORDS)
ARTICLES
Discrepancies between Doppler and catheter gradients in aortic prosthetic valves in vitro. A manifestation of localized gradients and pressure recovery
Division of Cardiology and Cardiovascular Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048.
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