Pulsed Doppler indices were devised in order to grade the severity of mitral regurgitation on a quantitative basis. Indices were obtained by mapping the regurgitant jet by recording abnormal systolic Doppler signals detected on a "yes/no" basis using a 3 MHz pulsed Doppler velocimeter associated with a cross sectional real time ultrasonic scanner. Combined information from two echographic planes was used to take into account the geometrical three dimensional configuration of the jet. The following dimensions of the jet were measured: (a) the length and the height in the long axis view of the left atrium (long axis regurgitant index (LARI), 0.5 X length X height); (b) the width at the annulus in the short axis view (short axis regurgitant index (SARI); (c) the total regurgitant index (TRI) calculated as the product of LARI multiplied by SARI. Sixteen normal subjects and 94 patients including 46 cases of mitral regurgitation confirmed by angiography (32 of whom proceeded to surgery) were investigated. The diagnostic sensitivity was 91% and the specificity 94%. The jet was detected in 76% of cases. Indices were correlated with independently performed angiographic grading on a three point scale. The best linear correlation was obtained for the TRI; mean values were significantly increased for each grade of severity. Correlations with invasive procedures showed an 87% success rate for the Doppler prediction of the involved regurgitant leaflet(s) and of the anatomical site of the lesion at the annulus. In addition, an abnormal diastolic signal was found in five of the eight patients with ruptured chordae and also a decreased percentage of systolic shortening of the annulus diameter in patients with mitral regurgitation compared with those without.
2D echo-Doppler flow mapping was applied to regurgitations due to mitral valve prolapse, acccording to a methodology previously described for mitral regurgitation of various origins. The study involved 34 patients with 37 prolapses, all invasively confirmed. Three important orders of information were successfully provided by this procedure. (1) The presence of flow anomalies was diagnostic, with sensitivity and specificity ranging between 91 and 93 % of cases, respectively. (2) The three-dimensional spreading of the flow anomalies was used to calculate indices of severity which enabled a classification of severity on a three-grade scale. Correlations with invasive procedures were satisfactory in 87% of the diagnosed cases. (3) More specifically, the site of the flow anomalies and atrial location of the regurgitation led to predict which was the involved leaflet, which part of it was regurgitant, and the presence and site of eventual chordae ruptures, with a percentage of satisfactory correlations ranging between 86 and 100% of cases. All three orders of information appear of conspicuous value for the management of these patients, particularly in view of eventual reconstructive surgery.
Color Doppler flow mapping was used in a group of 53 patients with mitral regurgitation confirmed by invasive procedures. All patients had associated mitral stenosis and were divided into three subgroups; (1) patients suffering from severe stenosis with mild regurgitation; (2) patients with lesions of equal or nearly equal severity, and (3) patients with severe regurgitation with mild stenosis. Grading of the regurgitation was made from a threedimensional index (total regurgitant index) by means of on-line measurements of ECG-gated two-dimensional Doppler color images of the regurgitant jet, with, when colored areas were not clearly delineated, assessment of the nature of the surrounding flow using a single-gated Doppler. Purposes were (1) to study the reliability of this grading in the presence of associated stenosis and (2) to define the Doppler characteristics of jets in such cases as compared with angiography and surgery. The diagnostic sensitivity for mitral regurgitation was 100%, the specificity 92, and the grading was satisfactory in 88% of the patients. Mitral jets were directed towards the center of the atrium in long-axis view in 80% of the patients, mainly in subgroups 1 and 2, with angiographic confirmation of the direction in all but 1 patient. The other jets were eccentric (20%), with angiographic confirmation in 70% of the patients, mainly of subgroup 3, having various grades of associated prolapses and/or commissural calcifications at surgery. In conclusion, the assessment of the regurgitation remained clinically pertinent, in spite of the presence of a stenosis. Recognition of the characteristics of jets provided useful preoperative information which may help in the choice of the surgical procedure.
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