Doppler color flow mapping in the evaluation of prosthetic mitral and aortic valve function

Abstract

Doppler color flow mapping and color-guided conventional Doppler studies were performed on 119 patients with 126 prosthetic valves (mitral alone in 60, aortic alone in 52 and both mitral and aortic in 7 patients) within 2 weeks of the catheterization study or surgery, or both. The mean pressure gradients derived by color-guided continuous wave Doppler ultrasound correlated well with those obtained at catheterization for both the tissue and mechanical mitral and aortic prostheses (r = 0.85 to 0.87). For the effective prosthetic orifice areas, better correlation with catheterization results were obtained with the tissue mitral (r = 0.94) and tissue aortic (r = 0.87) prostheses than with the mechanical mitral (r = 0.79) and mechanical aortic (r = 0.76) prostheses. The maximal width of the color flow signals at their origin from the tissue mitral prostheses also correlated well with the effective prosthetic orifice area at catheterization (r = 0.81). Doppler color flow mapping identified prosthetic valvular regurgitation with a sensitivity and specificity of 89% and 100%, respectively, for the mitral and 92% and 83% for the aortic prostheses. There was complete agreement between the Doppler color flow mapping and angiographic grading of the severity of prosthetic valvular regurgitation in 90% of mitral and 73.5% of the aortic regurgitant prostheses with under- or overestimation by greater than 1 grade in only two cases. Valvular and paravalvular regurgitation was correctly categorized by Doppler color flow mapping in relation to the surgical findings in 94% of the mitral and 80.5% of the aortic prostheses.

Multimodality Imaging in Transcatheter Aortic Valve Implantation and Post-Procedural Aortic Regurgitation

“…3B) were measured at end-diastole, also in the parasternal long-axis view. The degree of post-procedural AR was assessed semiquantitatively with color flow Doppler according to current guidelines and was considered significant if moderate or greater (13,14). Intraobserver and interobserver variability, agreement, and interstudy reproducibility.…”

Prevalence and severity of paravalvular regurgitation in the Artificial Valve Endocarditis Reduction Trial (AVERT) echocardiography study

“…The RJA was expressed as a percentage of the left atrial area (LAA) obtained in the same plane as the maximum regurgitant area (9,10). Mild mitral PVR was defined as maximum RJA/LAA Ͻ20%; moderate mitral PVR between 20% and 40%; and severe mitral PVR as Ͼ40%; and 2) for AVR, the prosthetic aortic valve regurgitation required a measurement of the proximal jet width evaluated in multiple views, and the widest proximal jet width was measured.…”

Prosthetic heart valves: Types and echocardiographic evaluation

“…Leakage backflow may increase with time and become a problem clinically, especially under conditions of low cardiac output and tachycardia [91]. Certain features on 2D and Doppler echocardiography may provide clues to the severity of regurgitation [76][77][78]. Detection of regurgitant jet more than 2 cm into the left atrium or the left ventricular cavity is often suggestive of significant regurgitation [57].…”

“…The acoustic shadowing from prosthesis may lead to nonvisualization or underestimation of the severity of the regurgitation, especially with mechanical valves [88][89][90][91][92][93][94]. The transthoracic approach is better for the evaluation of aortic prosthetic valve regurgitation than the mitral prosthetic valve regurgitation because the prosthesis at aortic position does not interface in between the transducer and the regurgitant jet [77][78][79][80][81].…”