TY - JOUR
T1 - Doppler evaluation of severity of mitral regurgitation
T2 - Relation to pulmonary venous blood flow patterns in an animal study
AU - Teien, Dag E.
AU - Jones, Michael
AU - Shiota, Takahiro
AU - Yamada, Izumi
AU - Sahn, David J.
N1 - Funding Information:
The quantitative evaluation of mitral regurgitation is difficult in the clinical setting. Left ventricular angiography is widely used for grading the severity of rnitral regurgitation; however, this method is semiquantitative at best (1). A variety of pulsed and color Doppler echocardiographic methods for evaluating mitral regurgitation have been proposed, and these have often been compared to angiography (2,3); however, no Doppler-derived method has gained widespread acceptance. The present study was undertaken to investigate the interrelations of regurgitant volume, hemodynamic variables and Doppler-derived patterns of pulmonary venous blood flow in an experimental preparation of chronic mitral regurgitation in which Institute, National Institutes of Health, Bethesda, Maryland. This study was supported in part by Grant HL 43287 from the NationalH eart, Lung,a nd Blood Institute, National Institutes of Health. Dr. Teien was supportedb y the Swedish Societyo f Medicine,S tockholm,S weden, for the period during which this work was performed.
PY - 1995/1
Y1 - 1995/1
N2 - Objectives. This study examined the influence of regurgitant volume on pulmonary venous blood flow patterns in an animal model with quantifiable mitral regurgitation. Background. Systolic pulmonary venous blood flow is influenced by atrial filling and compliance and ventricular output and by the presence of mitral regurgitation. The quantitative severity of the regurgitant volume itself is difficult to judge in clinical examinations. Methods. Six sheep with chronic mitral regurgitation produced by previous operation to create chordal damage were examined. At reoperation the heart was exposed and epicardial echocardiography performed. Pulmonary venous blood flow waveforms were recorded by pulsed Doppler under color flow Doppler guidance using a Vingmed 750 scanner. The pulmonary venous systolic inflow to the left atrium was expressed as a fraction of the total inflow velocity time integral. Flows across the aortic and mitral valves were recorded by electromagnetic flowmeters balanced against each other. Pressures in the left ventricle and left atrium were measured directly with high fidelity manometer-tipped catheters. Preload and afterload were systematically manipulated, resulting in 24 stable hemodynamic states. Results. Simple logarithmic correlation between the regurgitant volume and size of a positive or negative pulmonary venous inflow velocity time integral during systole was good (r = -0.841). By stepwise linear regression analysis with pulmonary venous negative systolic velocity time integral as a dependent variable compared with the regurgitant volume, fractional shortening, left atrial ν wave size, systemic vascular resistance and left ventricular systolic pressure, only contributions from ν wave size and regurgitant volume (r = 0.80) reached statistical significance in determining pulmonary venous negative systolic flow. Conclusions. Evaluation of systolic pulmonary venous blood flow velocity time integral can give valuable information helpful for estimating the regurgitant volume secondary to mitral regurgitation.
AB - Objectives. This study examined the influence of regurgitant volume on pulmonary venous blood flow patterns in an animal model with quantifiable mitral regurgitation. Background. Systolic pulmonary venous blood flow is influenced by atrial filling and compliance and ventricular output and by the presence of mitral regurgitation. The quantitative severity of the regurgitant volume itself is difficult to judge in clinical examinations. Methods. Six sheep with chronic mitral regurgitation produced by previous operation to create chordal damage were examined. At reoperation the heart was exposed and epicardial echocardiography performed. Pulmonary venous blood flow waveforms were recorded by pulsed Doppler under color flow Doppler guidance using a Vingmed 750 scanner. The pulmonary venous systolic inflow to the left atrium was expressed as a fraction of the total inflow velocity time integral. Flows across the aortic and mitral valves were recorded by electromagnetic flowmeters balanced against each other. Pressures in the left ventricle and left atrium were measured directly with high fidelity manometer-tipped catheters. Preload and afterload were systematically manipulated, resulting in 24 stable hemodynamic states. Results. Simple logarithmic correlation between the regurgitant volume and size of a positive or negative pulmonary venous inflow velocity time integral during systole was good (r = -0.841). By stepwise linear regression analysis with pulmonary venous negative systolic velocity time integral as a dependent variable compared with the regurgitant volume, fractional shortening, left atrial ν wave size, systemic vascular resistance and left ventricular systolic pressure, only contributions from ν wave size and regurgitant volume (r = 0.80) reached statistical significance in determining pulmonary venous negative systolic flow. Conclusions. Evaluation of systolic pulmonary venous blood flow velocity time integral can give valuable information helpful for estimating the regurgitant volume secondary to mitral regurgitation.
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U2 - 10.1016/0735-1097(94)00338-Q
DO - 10.1016/0735-1097(94)00338-Q
M3 - Article
C2 - 7798514
AN - SCOPUS:0028838020
SN - 0735-1097
VL - 25
SP - 264
EP - 268
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 1
ER -