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Figure 5 Examples of patient application of the broad-beam spectral Doppler method—maximal velocities. (Top) Patient with ischemic cardiomyopathy and a dilated left ventricle with poor global function and functional mitral regurgitation. Four-chamber view with color Doppler depicts a central regurgitant jet with a narrow proximal jet width in this view (broader in perpendicular views not shown). The power-velocity integral analysis of the manually traced narrow-spectrum vena contracta Doppler signal provided an average flow cross-sectional area of 0.30 cm² and regurgitant stroke volume (RSV) of 28.7 ml, with a corresponding magnetic resonance imaging (MRI) RSV of 27.9 ml (moderate regurgitation). (Middle) Patient receiving long-term dialysis with degenerated and calcified mitral leaflets but only mildly impaired left ventricular function. Color Doppler showed a large regurgitant jet into the dilated left atrium and reversed flow in the pulmonary vein. The PVI analysis provided a relatively large flow cross-sectional area (CSA) of 0.51 cm², with an RSV of 35.4 ml (31.5 ml by MRI). Note the importance of the duration of regurgitation on RSV calculation, here causing a smaller RSV relative to the CSA compared with the patient above due to the shorter period of flow of 380 versus 470 ms; the velocities driving flow across the regurgitant orifice are also lower in this second patient, extending only to 4.5 m/s, as opposed to a peak orifice velocity of 5.0 m/s in the above patient (spectral tracings on the right). (Bottom) Patient with ischemic cardiomyopathy and leaflet malcoaptation, with an eccentric wall jet attached to the lateral left atrial wall. The PVI analysis of the vena contracta Doppler spectrum revealed a flow CSA of 0.33 cm² and an RSV of 23.7 ml (30 ml by MRI). (In all three cases, maximal high pulse-repetition frequency Doppler velocities corresponded with left ventricular-to-left atrial pressure gradients estimated from systolic pressure (top: 508 cm/s vs. 120 mm Hg; middle: 466 cm/s vs. 100 mm Hg; bottom: 500 cm/s vs. 115 mm Hg, assuming a left atrial pressure of 15 mm Hg, or slightly lower, as brachial cuff pressure mildly overestimates left ventricular pressure.)