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(Circulation. 1999;99:1611-1617.)
© 1999 American Heart Association, Inc.

Basic Science Reports

Three-Dimensional Reconstruction of the Color Doppler–Imaged Vena Contracta for Quantifying Aortic Regurgitation

Studies in a Chronic Animal Model

Yoshiki Mori, MD; Takahiro Shiota, MD, PhD; Michael Jones, MD; Suthep Wanitkun, MD; Timothy Irvine, MD; Xiaokui Li, MD; Alain Delabays, MD; Natesa G. Pandian, MD; David J. Sahn, MD

From the Clinical Care Center for Congenital Heart Disease (Y.M., S.W., T.I., X.L., D.J.S.), Oregon Health Sciences University, Portland; The Cleveland Clinic Foundation (T.S.), Cleveland, Ohio; The Laboratory of Animal Medicine and Surgery (M.J.), National Heart, Lung, and Blood Institute, Bethesda, Md; and Noninvasive Cardiac Laboratory (A.D., N.G.P.), Tufts-New England Medical Center, Boston, Mass.

Correspondence to Michael Jones, MD, NIH/National Heart, Lung, and Blood Institute, 9000 Rockville Pike, Bldg 14E, Room 1074A, Bethesda, MD 20892.

Background—The purpose of this study was to investigate the use of 3-dimensional (3D) reconstruction of color Doppler flow maps to image and extract the vena contracta cross-sectional area to determine the severity of aortic regurgitation (AR) in an animal model. Evaluation of the vena contracta with 2-dimensional imaging systems may not be sufficiently robust to fully characterize this region, which may be asymmetrically shaped.

Methods and Results—In 6 sheep with surgically induced chronic AR, 18 hemodynamically different states were studied. Instantaneous regurgitant flow rates were obtained by aortic and pulmonary electromagnetic flowmeters (EMFs) as reference standards, and aortic regurgitant effective orifice areas (EOAs) were determined from EMF regurgitant flow rates divided by continuous-wave (CW) Doppler velocities. Composite video data for color Doppler imaging of the aortic regurgitant flows were transferred into a TomTec computer after computer-controlled 180° rotational acquisition. After the 3D data transverse to the flow jet were sectioned, the smallest proximal jet cross section was identified for direct measurement of the vena contracta area. Peak regurgitant flow rates and regurgitant stroke volumes were calculated as the product of these areas and the CW Doppler peak velocities and velocity-time integrals, respectively. There was an excellent correlation between the 3D-derived vena contracta areas and reference EOAs (r=0.99, SEE=0.01 cm²) and between 3D and reference peak regurgitant flow rates and regurgitant stroke volumes (r=0.99, difference=0.11 L/min; r=0.99, difference=1.5 mL/beat, respectively).

Conclusions—3D-based determination of the vena contracta cross-sectional area can provide accurate quantification of the severity of AR.

Key Words: blood flow • regurgitation • echocardiography • imaging

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