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An enhanced method for determining cardiac output using Doppler color flow imaging techniques to measure mitral orifice diameter was developed and validated in an experimental model and in clinical patients. In an in vitro circuit model, color jet width correlated well with actual orifice dimension from 12 to 24 mm (r = 0.99). In the clinical application, mitral valve area was calculated as a X b X pi/4 where a and b represent the width of the color flow stream in the mitral orifice just distal to the annulus in apical long-axis (short-diameter) and 4-chamber (90 degrees rotated, long-diameter) views, respectively. Cardiac output was then computed as the product of mitral valve area and time-velocity integral of transmitral flow from the same site. Cardiac output was also measured by thermodilution and conventional echocardiographic methods using diameters and time-velocity integrals from the left ventricular outflow tract. In 30 patients with nonvalvular heart disease, cardiac output measured by thermodilution ranged from 3.40 to 8.40 L/min. Cardiac output was determined in 28 of 30 patients (93%) by the Doppler color flow imaging technique; it ranged from 3.00 to 8.36 L/min and correlated well with thermodilution: y = 0.90x + 0.63, r = 0.91. Cardiac output was determined in 24 of 30 patients by the conventional left ventricular outflow method (80%). The cardiac output measured by the conventional method correlated less closely with thermodilution (r = 0.84), although there was no statistical difference in correlation coefficiencies between the 2 methods. These results indicate that the Doppler color flow imaging technique can be used to enhance the determination of cardiac output by echocardiography, particularly when the conventional method has resulted in technically inadequate recordings.

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Infective mitral valve endocarditis developed in a 35-year-old male patient after a percutaneous transvenous mitral commissurotomy (PTMC). The echocardiogram demonstrated vegetation in the anterior leaflet of the mitral valve and blood culture showed growth of Pseudomonas species which was sensitive to Ceftazidime, Ciprofloxacin, Cotrimoxazole and Imipenem and resistant to Amikacin, Ceftriaxone, Gentamycin and Nitilmycin. The patient underwent treatment with intravenous ceftazidime and ciprofloxacin for six weeks and patient improved significantly and got cure of the disease. Infective mitral valve endocarditis should be recognized as a potentially lethal complication after PTMC. The important measures to prevent bacteremia during PTMC and the appropriate role of antibiotics and operation are discussed. Keywords: PTMC; Infective endocarditis. DOI: 10.3329/cardio.v2i2.6649Cardiovasc. j. 2010; 2(2) : 252-255