Quantification of pressure gradients across stenotic valves by Doppler ultrasound

Two-dimensional echocardiography has proven very useful in assessing valvular heart disease, but the technique is limited in certain groups of patients and is unable to quantify a transvalvular pressure gradient. Advances in the Doppler ultrasound techniques have made it possible to noninvasively measure velocity of flow across a stenotic heart valve and to calculate the pressure gradient. A commercially available, continuous and pulse wave Doppler instrument was utilized to assess the transvalvular pressure gradient in patients with mitral and aortic stenosis and the transmitral pressure half-time to calculate mitra valve area. Thirty-five consecutive adult patients with suspected aortic stenosis and 30 adult patients with suspected mitral stenosis underwent Doppler ultrasound examination within 24 hours of cardiac catheterization. An adequate Doppler examination was obtained in 81% of the patients with aortic stenosis, with a correlation between the Doppler-derived transaortic gradient and the catheterization-derived gradient of 0.94. The Doppler-measured gradient accurately separated those patients with significant aortic stenosis (gradients of greater than 50 mm Hg) from those patients with noncritical aortic stenosis. Similarly, an adequate Doppler examination was obtained in 90% of the adult patients with mitral stenosis. There was also close correlation between the mitral valve area and mean pressure gradient measured by the Doppler technique and that obtained at the time of cardiac catheterization (r = 0.87 and 0.85, respectively). The Doppler technique proved to be useful in those patients who had also undergone prior mitral commissurotomy. This study confirms that the combined continuous pulse wave Doppler technique will serve as a valuable addition to the diagnostic capabilities offered by echocardiography.

This article has been cited by other articles:

				K. L. Strub Adult Echocardiography and Doppler Journal of Diagnostic Medical Sonography, March 1, 2005; 21(2): 91 - 110. [Abstract] [PDF]

				Z. Golbathy, O. Ucar, A. G. Yuksel, O. Gulel, S. Aydogdu, and V. Ulusoy Plasma brain natriuretic peptide levels in patients with rheumatic heart disease Eur J Heart Fail, October 1, 2004; 6(6): 757 - 760. [Abstract] [Full Text] [PDF]

				D. Kim and M. E. Tavel Assessment of Severity of Aortic Stenosis Through Time-Frequency Analysis of Murmur Chest, November 1, 2003; 124(5): 1638 - 1644. [Abstract] [Full Text] [PDF]

				C. Irace, A. Gnasso, F. Cirillo, G. Leonardo, M. Ciamei, A. Crivaro, A. Renzulli, and M. Cotrufo Arterial Remodeling of the Common Carotid Artery After Aortic Valve Replacement in Patients With Aortic Stenosis Stroke, October 1, 2002; 33(10): 2446 - 2450. [Abstract] [Full Text] [PDF]

				S. Nakatani, M. S. Firstenberg, N. L. Greenberg, P. M. Vandervoort, N. G. Smedira, P. M. McCarthy, and J. D. Thomas Mitral inertance in humans: critical factor in Doppler estimation of transvalvular pressure gradients Am J Physiol Heart Circ Physiol, March 1, 2001; 280(3): H1340 - H1345. [Abstract] [Full Text] [PDF]

				Z. Golbasl, S. Dincer, H. Bayol, B. Ugurlu, D. Cicek, T. Keles, S. Aydogdu, and D. Erbas Increased nitric oxide in exhaled air in patients with rheumatic heart disease Eur J Heart Fail, January 1, 2001; 3(1): 27 - 32. [Abstract] [Full Text] [PDF]

				M. D. Cheitlin, J. S. Alpert, W. F. Armstrong, G. P. Aurigemma, G. A. Beller, F. Z. Bierman, T. W. Davidson, J. L. Davis, P. S. Douglas, L. D. Gillam, et al. ACC/AHA Guidelines for the Clinical Application of Echocardiography : A Report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines (Committee on Clinical Application of Echocardiography) Developed in Collaboration With the American Society of Echocardiography Circulation, March 18, 1997; 95(6): 1686 - 1744. [Full Text]

				B. Chakraborty, S. Quek, Ding Zee Pin, Chee Tek Siong, and Tan Lay Kheng Doppler Echocardiographic Assessment of Normally Functioning Starr-Edwards, Carbomedics and Carpentier-Edwards Valves in Aortic Position Angiology, May 1, 1996; 47(5): 481 - 489. [Abstract] [PDF]

				A. D. Waggoner, B. Barzilai, and J. E. Perez Two-Dimensional Doppler Echocardiographic Derived Aortic Valve Area in Aortic Stenosis Journal of Diagnostic Medical Sonography, March 1, 1991; 7(2): 64 - 72. [Abstract] [PDF]

				R. Taylor Assessing Mitral Stenosis with Doppler Echocardiography: Limitations of the Pressure Half-Time Method Journal of Diagnostic Medical Sonography, July 1, 1990; 6(4): 219 - 223. [Abstract] [PDF]

				R. Taylor Interpretation of the Correlation Coefficient: A Basic Review Journal of Diagnostic Medical Sonography, January 1, 1990; 6(1): 35 - 39. [Abstract] [PDF]

				R. T. Lee, S. J. S. Bhatia, and M. G. S. J. Sutton Assessment of Valvular Heart Disease With Doppler Echocardiography JAMA, October 20, 1989; 262(15): 2131 - 2135. [Abstract] [PDF]

				C. M. Otto and A. S. Pearlman Doppler Echocardiography in Adults With Symptomatic Aortic Stenosis: Diagnostic Utility and Cost-effectiveness Arch Intern Med, December 1, 1988; 148(12): 2553 - 2560. [Abstract] [PDF]

				M. D. Smith, O. L. Kwan, and A. N. DeMaria Value and Limitations of Continuous-Wave Doppler Echocardiography in Estimating Severity of Valvular Stenosis JAMA, June 13, 1986; 255(22): 3145 - 3151. [Abstract] [PDF]