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CLINICAL STUDY

Assessment of aortic regurgitation by transesophageal color Doppler imaging of the vena contracta: validation against an intraoperative aortic flow probe

^a Department of Internal Medicine, Division of Cardiology, UT Southwestern Medical Center and Dallas VA Medical Center, Dallas, Texas, USA
^b Department of Cardiovascular and Thoracic Surgery, UT Southwestern Medical Center and Dallas VA Medical Center, Dallas, Texas, USA

Manuscript received November 15, 2000; accepted December 20, 2000.

Reprint requests and correspondence: Dr. Paul A. Grayburn, Chief, Cardiology Section (111A), Dallas VA Medical Center, 4500 South Lancaster Road, Dallas, Texas 75216
Grayburn{at}ryburn.swmed.edu

OBJECTIVES

This study was performed to validate the accuracy of color flow vena contracta (VC) measurements of aortic regurgitation (AR) severity by comparing them to simultaneous intraoperative flow probe measurements of regurgitant fraction (RgF) and regurgitant volume (RgV).

BACKGROUND

Color Doppler imaging of the vena contracta has emerged as a simple and reliable measure of the severity of valvular regurgitation. This study evaluated the accuracy of VC imaging of AR by transesophageal echocardiography (TEE).

METHODS

A transit-time flow probe was placed on the ascending aorta during cardiac surgery in 24 patients with AR. The flow probe was used to measure RgF and RgV simultaneously during VC imaging by TEE. Flow probe and VC imaging were interpreted separately and in blinded fashion.

RESULTS

A good correlation was found between VC width and RgF (r = 0.85) and RgV (r = 0.79). All six patients with VC width >6 mm had a RgF >0.50. All 18 patients with VC width <5 mm had a RgF <0.50. Vena contracta area also correlated well with both RgF (r = 0.81) and RgV (r = 0.84). All six patients with VC area >7.5 mm² had a RgF >0.50, and all 18 patients with a VC area <7.5 mm² had a RgF <0.50. In a subset of nine patients who underwent afterload manipulation to increase diastolic blood pressure, RgV increased significantly (34 ± 26 ml to 41 ± 27 ml, p = 0.042) while VC width remained unchanged (5.4 ± 2.8 mm to 5.4 ± 2.8 mm, p = 0.41).

CONCLUSIONS

Vena contracta imaging by TEE color flow mapping is an accurate marker of AR severity. Vena contracta width and VC area correlate well with RgF and RgV obtained by intraoperative flow probe. Vena contracta width appears to be less afterload-dependent than RgV.

Abbreviations and Acronyms   AR = aortic regurgitation   CABG = coronary artery bypass grafting   RgF = regurgitant fraction   RgV = regurgitant volume   TEE = transesophageal echocardiography   VC = vena contracta

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