Validation of the proximal flow convergence method. Calculation of orifice area in patients with mitral stenosis.

Rodriguez, L. Leonardo; Thomas, James D.; Monterroso, Victor; Weyman, Arthur E.; Harrigan, Pamela; Mueller, Licia; Levine, Robert A.

doi:10.1161/01.cir.88.3.1157

Cited by 126 publications

(39 citation statements)

References 35 publications

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“…Overestimation of MVA by misinterpretation of a short pressure half-time can be avoided by calculating MVA using alternative methods 3,10,25,26 (the Table), particularly when mitral pressure gradients are higher than expected for the observed half-time. C n should be calculated and PAP assessed during stress echocardiography.…”

Section: The Syndrome Of Short Pressure Half-time In Severe Mitral Stmentioning

confidence: 99%

Impact of Atrioventricular Compliance on Pulmonary Artery Pressure in Mitral Stenosis

et al. 2000

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Background-The decay of the pressure gradient across a stenotic mitral valve is determined by the size of the orifice and net AV compliance (C n ). We have observed a group of symptomatic patients, usually in sinus rhythm, characterized by pulmonary hypertension (particularly during exercise) despite a relatively large mitral valve area by pressure half-time. We speculated that this discrepancy was due to low atrial compliance causing both pulmonary hypertension and a steep decay of the transmitral pressure gradient despite significant stenosis. We therefore tested the hypothesis that C n is an important physiological determinant of pulmonary artery pressure at rest and during exercise in mitral stenosis. Methods and Results-Twenty patients with mitral stenosis were examined by Doppler echocardiography. C n , calculated from the ratio of effective mitral valve area (continuity equation) and the E-wave downslope, ranged from 1.7 to 8.1 mL/mm Hg. Systolic pulmonary artery pressure (PAP) increased from 43Ϯ12 mm Hg at rest to 71Ϯ23 mm Hg (range, 40 to 110 mm Hg) during exercise. There was a particularly close correlation between C n and exercise PAP (rϭϪ0.85).Patients with a low compliance were more symptomatic (PϽ0.025). Catheter-and Doppler-derived values for C n , determined in 10 cases, correlated well (rϭ0.79). Conclusions-C n , which can be noninvasively assessed, is an important physiological determinant of PAP in mitral stenosis. Patients with low C n represent an important clinical entity, with symptoms corresponding to severe increases in PAP during stress echocardiography.

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Section: The Syndrome Of Short Pressure Half-time In Severe Mitral Stmentioning

confidence: 99%

Impact of Atrioventricular Compliance on Pulmonary Artery Pressure in Mitral Stenosis

et al. 2000

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“…In addition, accurate measurement of the pressure half-time is dependent on a clear delineation of the envelope of a continuous-wave signal. MVA was also determined using the Doppler continuity equation and the proximal isovelocity surface area method [14, 15, 16], but these methods have some drawbacks, and are more complicated than the pressure half-time and direct planimetry.…”

Section: Discussionmentioning

confidence: 99%

“…This method cannot accurately estimate the MVA in the presence of severe aortic regurgitation and left ventricular dysfunction [8, 9, 10, 11, 12, 13]. MVA is also determined by the use of the Doppler continuity equation and the proximal isovelocity surface area method, but these methods also have some drawbacks, and are time-consuming [14, 15, 16]. …”

Section: Introductionmentioning

confidence: 99%

Application of the Vena contracta Method for the Calculation of the Mitral Valve Area in Mitral Stenosis

et al. 2002

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Objectives: The vena contracta is the narrowest region of the regurgitant or stenotic jet just downstream the orifice and reflects the size of that orifice. This study was performed to assess the accuracy of the vena contracta width (VCW) in evaluating the severity of mitral stenosis (MS) and to compare the mitral valve area (MVA) determined by VCW with MVAs obtained by other more traditional echocardiographic methods. Methods: We studied 59 patients (43 females, 42 ± 14 years) with MS. VCW was measured in the apical four chamber view by Doppler color flow mapping. The largest diameter of the VCW during diastole was measured for at least three cardiac cycles and averaged. MVA was calculated from the following equation: πr², where r = VCW/2. MVA was also determined by planimetry, the pressure half-time method, and by the Gorlin formula. Results: In this study, the width of the vena contracta ranged from 0.89 to 1.73 cm (mean 1.30 ± 0.21). MVA, calculated based on the VCW, ranged from 0.63 to 2.35 cm² (mean 1.36 ± 0.41). MVA by VCW (1.36 ± 0.41 cm²) showed good correlations with three comparative techniques: (1) the cross-sectional area by planimetry (1.35 ± 0.36 cm², mean difference = 0.21 ± 0.16 cm², y = 0.91x + 0.14, r = 0.79, SEE = 0.26 cm², p < 0.001); (2) the area derived from the Doppler pressure half-time (1.27 ± 0.32 cm², mean difference = 0.22 ± 0.19 cm², y = 0.97x + 0.13, r = 0.76, SEE = 0.27 cm², p < 0.001), and (3) the area derived from the Gorlin equation in the 18 patients who underwent catheterization (1.27 ± 0.35 cm², mean difference = 0.19 ± 0.16, y = 0.98x + 0.05, r = 0.81, SEE = 0.26 cm², p < 0.001). Conclusions: These findings suggest that Doppler color flow imaging of the MS jet in the vena contracta can provide an accurate estimation of MVA and appears to be potentially applicable in the assessment of the severity of MS.

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“…30 The PISA method for estimation of MVA has been validated in patients with RMS. 69 The PISA method appears to have several advantages compared to the PHT method. It has been shown to be less or not affected by MR, 69 AF, 70 AR, 71 and changes in atrio-ventricular compliance.…”

Section: Proximal Isovelocity Surface Area Methodsmentioning

confidence: 99%

“…69 The PISA method appears to have several advantages compared to the PHT method. It has been shown to be less or not affected by MR, 69 AF, 70 AR, 71 and changes in atrio-ventricular compliance. 72 However the PISA method is technically difficult, more time consuming and susceptible to measurement errors.…”

Section: Proximal Isovelocity Surface Area Methodsmentioning

confidence: 99%

Echocardiographic Assessment of Degenerative Mitral Stenosis: A Diagnostic Challenge of an Emerging Cardiac Disease

Oktay¹,

Gilliland²,

Lavie³

et al. 2017

Current Problems in Cardiology

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Validation of the proximal flow convergence method. Calculation of orifice area in patients with mitral stenosis.

Abstract: These results validate the proximal flow convergence concept in the clinical setting and also demonstrate that it can be extended to orifice area calculation using the continuity equation.

Cited by 126 publications

References 35 publications

Impact of Atrioventricular Compliance on Pulmonary Artery Pressure in Mitral Stenosis

Impact of Atrioventricular Compliance on Pulmonary Artery Pressure in Mitral Stenosis

Application of the Vena contracta Method for the Calculation of the Mitral Valve Area in Mitral Stenosis

Echocardiographic Assessment of Degenerative Mitral Stenosis: A Diagnostic Challenge of an Emerging Cardiac Disease

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