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EXPERIMENTAL STUDY

Interaliasing distance of the flow convergence surface for determining mitral regurgitant volume: a validation study in a chronic animal model

Marta Sitges, MD^*, Michael Jones, MD, Takahiro Shiota, PhD, FACC^*, David L. Prior, PhD^*, Jian Xin Qin, MD^*, Hiroyuki Tsujino, MS^*, Fabrice Bauer, MD^*, Yong Jin Kim, MD^*, Dimitri Deserranno, BSME^*, Neil L. Greenberg, PhD^*, Lisa A. Cardon, RDCS^*, Arthur D. Zetts, Mario J. Garcia, MD, FACC^* and James D. Thomas, MD, FACC^*

^* Cardiovascular Imaging Center, Department of Cardiology, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA

Manuscript received December 31, 2000; revised manuscript received May 10, 2001, accepted June 25, 2001.

Reprint requests and correspondence: Dr. Takahiro Shiota, Department of Cardiology/Desk F-15. The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio 44195
shiotat{at}ccf.org

OBJECTIVES

We aimed to validate a new flow convergence (FC) method that eliminated the need to locate the regurgitant orifice and that could be performed semiautomatedly.

BACKGROUND

Complex and time-consuming features of previously validated color Doppler methods for determining mitral regurgitant volume (MRV) have prevented their widespread clinical use.

METHODS

Thirty-nine different hemodynamic conditions in 12 sheep with surgically created flail leaflets inducing chronic mitral regurgitation were studied with two-dimensional (2D) echocardiography. Color Doppler M-mode images along the centerline of the accelerating flow towards the mitral regurgitation orifice were obtained. The distance between the two first aliasing boundaries (interaliasing distance [IAD]) was measured and the FC radius was mathematically derived according to the continuity equation (R_calc = IAD/(1 – ), v₁ and v₂ being the aliasing velocities). The conventional 2D FC radius was also measured (R_meas). Mitral regurgitant volume was then calculated according to the FC method using both R_calc and R_meas. Aortic and mitral electromagnetic (EM) flow probes and meters were balanced against each other to determine the reference standard MRV.

RESULTS

Mitral regurgitant volume calculated from R_calc and R_meas correlated well with EM-MRV (y = 0.83x + 5.17, r = 0.90 and y = 1.04x + 0.91, r = 0.91, respectively, p < 0.001 for both). However, both methods resulted in slight overestimation of EM-MRV ( was 3.3 ± 2.1 ml for R_calc and 1.3 ± 2.3 ml for R_meas).

CONCLUSIONS

Good correlation was observed between MRV derived from R_calc (IAD method) and EM-MRV, similar to that observed with R_meas (conventional FC method) and EM-MRV. The R_calc using the IAD method has an advantage over conventional R_meas in that it does not require spatial localization of the regurgitant orifice and can be performed semiautomatedly.

Abbreviations and Acronyms   CFD = computational fluid dynamics   CW = continuous wave   FC = flow convergence   IAD = interaliasing distance   MRV = mitral regurgitant volume   Rcalc = calculated radius   Rmeas = measured radius   RF = regurgitant fraction   ROA = regurgitant orifice area   2D = two-dimensional   VTI = velocity-time integral

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