Circulation, Vol 84, 1481-1489, Copyright © 1991 by American Heart Association
GS Bargiggia, L Tronconi, DJ Sahn, F Recusani, A Raisaro, S De Servi, LM Valdes- Cruz and C Montemartini
BACKGROUND. Imaging of the flow convergence region (FCR) proximal to a
regurgitant orifice has been shown to provide a method for quantifying the
regurgitant flow rate. According to the continuity principle, the FCR is
constituted by concentric hemispheric isovelocity surfaces centered at the
orifice. The flow rate is constant across all isovelocity surfaces and
equals the flow rate through the orifice. For any isovelocity surface the
flow rate (Q) is given by: Q = 2 pi r2 Vr, where 2 pi r2 is the area of the
hemisphere and Vr is the velocity at the radial distance (r) from the
orifice. METHODS AND RESULTS. We studied 52 consecutive patients with
mitral regurgitation (mean age, 49 years; age range, 21-66 years) verified
by left ventricular angiography using color flow mapping. The FCR r was
measured as the distance between the first aliasing limit--at a Nyquist
limit obtained by zero- shifting the velocity cutoff to 38 cm/sec--and the
regurgitant orifice. Seven patients without evidence of an FCR had only
grade 1+ mitral regurgitation angiographically. There was a significant
relation between the Doppler-derived maximal instantaneous regurgitant flow
rate and the angiographic degree of mitral regurgitation in the other
patients (rs = 0.91, p less than 0.001). The regurgitant flow rate by
Doppler also correlated with the angiographic regurgitant volume (r = 0.93,
SEE = 123 ml/sec) in the 15 patients in normal sinus rhythm and without
other regurgitant lesions in whom it could be measured. The correlation
between regurgitant jet area within the left atrium and the angiographic
grade was only fair (rs = 0.75, p less than 0.001). CONCLUSIONS. Color flow
Doppler provides new velocity information about the proximal FCR in
patients with mitral regurgitation. According to the continuity principle,
the maximal instantaneous regurgitant flow rate, obtained with the FCR
method, may provide a quantitative estimate of the severity of mitral
regurgitation, which is relatively independent of technical factors.
ARTICLES
A new method for quantitation of mitral regurgitation based on color flow Doppler imaging of flow convergence proximal to regurgitant orifice
IRCCS Policlinico S. Matteo, Division of Cardiology, Pavia, Italy.
This article has been cited by other articles:
 |
|
 |
|
  S. Buchner, K. Debl, F. Poschenrieder, S. Feuerbach, G. A.J. Riegger, A. Luchner, and B. Djavidani Cardiovascular Magnetic Resonance for Direct Assessment of Anatomic Regurgitant Orifice in Mitral Regurgitation Circ Cardiovasc Imaging, September 1, 2008; 1(2): 148 - 155. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P A Grayburn How to measure severity of mitral regurgitation Postgrad. Med. J., August 1, 2008; 84(994): 395 - 402. [Full Text] [PDF]
|
|
|
|
 |
|
 J-M Song, M-J Kim, Y-J Kim, S-H Kang, J-J Kim, D-H Kang, and J-K Song Three-dimensional characteristics of functional mitral regurgitation in patients with severe left ventricular dysfunction: a real-time three-dimensional colour Doppler echocardiography study Heart, May 1, 2008; 94(5): 590 - 596. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. G. Neilan, T.-T. Ton-Nu, Y. Kawase, R. Yoneyama, K. Hoshino, F. del Monte, R. J. Hajjar, M. H. Picard, R. A. Levine, and J. Hung Progressive nature of chronic mitral regurgitation and the role of tissue Doppler-derived indexes Am J Physiol Heart Circ Physiol, May 1, 2008; 294(5): H2106 - H2111. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. A Grayburn How to measure severity of mitral regurgitation Heart, March 1, 2008; 94(3): 376 - 383. [Full Text] [PDF]
|
|
|
|
 |
|
 W. Y. Szeto, R. C. Gorman, J. H. Gorman III, and M. A. Acker Ischemic Mitral Regurgitation Card. Surg. Adult, January 1, 2008; 3(2008): 785 - 802. [Full Text]
|
|
|
|
 |
|
 F. B. Tournoux, C. Alabiad, D. Fan, A. A. Chen, M. Chaput, E. K. Heist, T. Mela, M. Mansour, V. Reddy, J. N. Ruskin, et al. Echocardiographic measures of acute haemodynamic response after cardiac resynchronization therapy predict long-term clinical outcome Eur. Heart J., May 1, 2007; 28(9): 1143 - 1148. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. D. Thomas and Z. B. Popovic Assessment of Left Ventricular Function by Cardiac Ultrasound J. Am. Coll. Cardiol., November 21, 2006; 48(10): 2012 - 2025. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Lafitte, P. Bordachar, M. Lafitte, S. Garrigue, S. Reuter, P. Reant, K. Serri, V. Lebouffos, M. Berrhouet, P. Jais, et al. Dynamic Ventricular Dyssynchrony: An Exercise-Echocardiography Study J. Am. Coll. Cardiol., June 6, 2006; 47(11): 2253 - 2259. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. C. Porciani, R. Macioce, G. Demarchi, M. Chiostri, N. Musilli, F. Cappelli, A. Lilli, G. Ricciardi, and L. Padeletti Effects of cardiac resynchronization therapy on the mechanisms underlying functional mitral regurgitation in congestive heart failure Eur J Echocardiogr, January 1, 2006; 7(1): 31 - 39. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Meurin, M. C. Iliou, A. B. Driss, B. Pierre, S. Corone, P. Cristofini, J. Y. Tabet, and on behalf of the Working Group of Cardiac Rehabili Early Exercise Training After Mitral Valve Repair: A Multicentric Prospective French Study Chest, September 1, 2005; 128(3): 1638 - 1644. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Bordachar, S. Lafitte, S. Reuter, P. Sanders, P. Jais, M. Haissaguerre, R. Roudaut, S. Garrigue, and J. Clementy Echocardiographic parameters of ventricular dyssynchrony validation in patients with heart failure using sequential biventricular pacing J. Am. Coll. Cardiol., December 7, 2004; 44(11): 2157 - 2165. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Beinart, V. Boyko, E. Schwammenthal, R. Kuperstein, A. Sagie, H. Hod, S. Matetzky, S. Behar, M. Eldar, and M. S. Feinberg Long-term prognostic significance of left atrial volume in acute myocardial infarction J. Am. Coll. Cardiol., July 21, 2004; 44(2): 327 - 334. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. A. Zoghbi, M. Enriquez-Sarano, E. Foster, P. A. Grayburn, C. D. Kraft, R. A. Levine, P. Nihoyannopoulos, C. M. Otto, M. A. Quinones, H. Rakowski, et al. American Society of Echocardiography: recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography : A report from the American Society of Echocardiography's Nomenclature and Standards Committee and The Task Force on Valvular Regurgitation, developed in conjunction with the American College of Cardiology Echocardiography Committee, The Cardiac Imaging Committee, Council on Clinical Cardiology, The American Heart Association, and the European Society of Cardiology Working Group on Echocardiography, represented by: Eur J Echocardiogr, December 1, 2003; 4(4): 237 - 261. [Full Text] [PDF]
|
|
|
|
|
|
O. A. Breithardt, A. M. Sinha, E. Schwammenthal, N. Bidaoui, K. U. Markus, A. Franke, and C. Stellbrink Acute effects of cardiac resynchronization therapy on functional mitral regurgitation in advanced systolic heart failure J. Am. Coll. Cardiol., March 5, 2003; 41(5): 765 - 770. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. Stellin, V.L. Vida, O. Milanesi, G. Rizzoli, M. Rubino, M.A. Padalino, R. Bonato, and D. Casarotto Surgical treatment of complete A-V canal defects in children before 3 months of age Eur. J. Cardiothorac. Surg., February 1, 2003; 23(2): 187 - 193. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. C. Gorman, J. H. Gorman III, and L. H. Edmunds Jr. Ischemic Mitral Regurgitation Card. Surg. Adult, January 1, 2003; 2(2003): 751 - 769. [Full Text]
|
|
|
|
|
|
A. M. Gillinov and D. M. Cosgrove III Mitral Valve Repair Card. Surg. Adult, January 1, 2003; 2(2003): 933 - 950. [Full Text]
|
|
|
|
|
|
J. D Thomas DOPPLER ECHOCARDIOGRAPHIC ASSESSMENT OF VALVAR REGURGITATION Heart, December 1, 2002; 88(6): 651 - 657. [Full Text] [PDF]
|
|
|
|
|
|
S. Capomolla, G. Pinna, O. Febo, A. Caporotondi, G. Guazzotti, M. T. La Rovere, M. Gnemmi, A. Mortara, R. Maestri, and F. Cobelli Echo-Doppler mitral flow monitoring: an operative tool to evaluate day-to-day tolerance to and effectiveness of beta-adrenergic blocking agent therapy in patients with chronic heart failure J. Am. Coll. Cardiol., November 15, 2001; 38(6): 1675 - 1684. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Lebrun, P. Lancellotti, and L. A. Pierard Quantitation of functional mitral regurgitation during bicycle exercise in patients with heart failure J. Am. Coll. Cardiol., November 15, 2001; 38(6): 1685 - 1692. [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]
|
|
|
|
|
|
R. Hoffmann and P. Hanrath Interaliasing distances to assess mitral regurgitation: dividing the rainbow of flow convergence J. Am. Coll. Cardiol., October 1, 2001; 38(4): 1203 - 1206. [Full Text] [PDF]
|
|
|
|
 |
|
 M. Ishii, K. Hashino, G. Eto, T. Tsutsumi, W. Himeno, Y. Sugahara, H. Muta, J. Furui, T. Akagi, Y. Ito, et al. Quantitative Assessment of Severity of Ventricular Septal Defect by Three-Dimensional Reconstruction of Color Doppler-Imaged Vena Contracta and Flow Convergence Region Circulation, February 6, 2001; 103(5): 664 - 669. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T Irvine, X N Li, R Rusk, D Lennon, D J Sahn, and A Kenny Three dimensional colour Doppler echocardiography for the characterisation and quantification of cardiac flow events Heart, November 1, 2000; 84(90002): 2i - 6. [Full Text]
|
|
|
|
|
|
G. Stellin, M. Padalino, O. Milanesi, V. Vida, A. Favaro, M. Rubino, R. Biffanti, and D. Casarotto Repair of congenital mitral valve dysplasia in infants and children: is it always possible? Eur. J. Cardiothorac. Surg., July 1, 2000; 18(1): 74 - 82. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Thomas, E. Foster, J. I. E. Hoffman, and N. B. Schiller The mitral regurgitation index: an echocardiographic guide to severity J. Am. Coll. Cardiol., June 1, 1999; 33(7): 2016 - 2022. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. De Simone, G. Glombitza, C. F. Vahl, J.o. Albers, H. P. Meinzer, and S. Hagl Three-dimensional color doppler: a clinical study in patients with mitral regurgitation J. Am. Coll. Cardiol., May 1, 1999; 33(6): 1646 - 1654. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Y. Leung, J. Wong, L. Rodriguez, M. Pu, P. M. Vandervoort, and J. D. Thomas Application of Color Doppler Flow Mapping to Calculate Orifice Area of St Jude Mitral Valve Circulation, September 22, 1998; 98(12): 1205 - 1211. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. A. Khan, C. A. Herzog, J. V. St. Peter, G. G. Hartley, R. Madlon-Kay, C. D. Dick, R. W. Asinger, and J. T. Vessey The Prevalence of Cardiac Valvular Insufficiency Assessed by Transthoracic Echocardiography in Obese Patients Treated with Appetite-Suppressant Drugs N. Engl. J. Med., September 10, 1998; 339(11): 713 - 718. [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]
|
|
|
|
 |
|
 S. J. Weiss and J. S. Savino What Is the Best Way to Assess Mitral Regurgitation? Seminars in Cardiothoracic and Vascular Anesthesia, March 1, 1997; 1(1): 49 - 60. [PDF]
|
|
|
|
|
|
J. D. Thomas How Leaky Is That Mitral Valve?: Simplified Doppler Methods to Measure Regurgitant Orifice Area Circulation, February 4, 1997; 95(3): 548 - 550. [Full Text]
|
|
|
|
|
|
S. A. Hall, M. E. Brickner, D. L. Willett, W. N. Irani, I. Afridi, and P. A. Grayburn Assessment of Mitral Regurgitation Severity by Doppler Color Flow Mapping of the Vena Contracta Circulation, February 4, 1997; 95(3): 636 - 642. [Abstract] [Full Text]
|
|
|
|
|
|
T. Shiota, M. Jones, I. Yamada, R. S. Heinrich, M. Ishii, B. Sinclair, S. Holcomb, A. P. Yoganathan, and D. J. Sahn Effective Regurgitant Orifice Area by the Color Doppler Flow Convergence Method for Evaluating the Severity of Chronic Aortic Regurgitation : An Animal Study Circulation, February 1, 1996; 93(3): 594 - 602. [Abstract] [Full Text]
|
|
|
|
|
|
M. Enriquez-Sarano, L. J. Sinak, A. J. Tajik, K. R. Bailey, and J. B. Seward Changes in Effective Regurgitant Orifice Throughout Systole in Patients With Mitral Valve Prolapse : A Clinical Study Using the Proximal Isovelocity Surface Area Method Circulation, November 15, 1995; 92(10): 2951 - 2958. [Abstract] [Full Text]
|
|
|
|
|
|
M. Pu, P. M. Vandervoort, B. P. Griffin, D. Y. Leung, W. J. Stewart, D. M. Cosgrove III, and J. D. Thomas Quantification of Mitral Regurgitation by the Proximal Convergence Method Using Transesophageal Echocardiography : Clinical Validation of a Geometric Correction for Proximal Flow Constraint Circulation, October 15, 1995; 92(8): 2169 - 2177. [Abstract] [Full Text]
|
|
|
|
|
|
E.G. Cape, W. Jaarsma, and A.P. Yoganathan Echo Doppler principles, techniques and applications for the cardiac surgeon Eur. J. Cardiothorac. Surg., January 1, 1992; 6(suppl_1): S2 - S12. [Abstract] [PDF]
|
|