In 33 patients with confirmed mitral valve disease, the mitral valve flow velocity traces were recorded by means of a directional Doppler ultrasonic velocimeter using the transseptal route, and correlated with the clinical and haemodynamic data. In all cases, characteristic anomalies of the mitral flow velocity patterns were noted and could be related to the type of lesion, stenosis, regurgitation, or a combination of these. Furthermore, specific patterns of the flow velocity traces were shown to correlate satisfactorily with the degree of severity of the disease. The authors propose a pathophysiological interpretation of the anomalies of the velocity patterns, based on turbulence for stenosis and backward flow wave for regurgitation. They conclude that the transseptal directional Doppler catheterization provides a new reliable method for establishing the diagnosis andgrading the severity ofmitral valve disease usingpattern recognition, and, moreover, offers a new approach to the understanding ofmitral haemodynamic disturbances on a beat-to-beat basis.In the first part of this report (Kalmanson et al., I975), we demonstrated the possibility of recording blood flow velocity tracings of the normal mitral valve in patients by means of a directional Doppler ultrasonic catheter tip velocimeter placed at the site of the mitral annulus using the transseptal catheterization procedure.The purpose of the present report is to demonstrate the value of this new technique for diagnosing and evaluating mitral valve disease, using a pattern recognition method.
Subjects and methodsThirty-three patients were studied, I7 women and i6 men, ranging in age from 2I to 69 years (Table I, 2, 3). They included I5 patients with pure mitral stenosis, 8 with pure mitral regurgitation, and IO with associated mitral stenosis and regurgitation of rheumatic origin, some of whom had had bacterial endocarditis; I2 had associated aortic and/or tricuspid valve lesion; i8 were in sinus rhythm; and I5 were in atrial fibrillation.All patients underwent a routine diagnostic catheterization of the left heart using the transseptal route and the Telco' manometer, according to Forman's technique (Forman, Laurens, and Servelle, I962). Both atrial and ventricular pressures were recorded successively or 'Telco,
