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Validation of a digital color Doppler flow measurement method for pulmonary regurgitant volumes and regurgitant fractions in an in vitro model and in a chronic animal model of postoperative repaired tetralogy of Fallot

Yoshiki Mori, MD^*, Timothy Irvine, MD^*, Michael Jones, MD, Rosemary A. Rusk, MD^*, Quynh Pham, MS^*, Antoinette Kenny, MD and David J. Sahn, MD, FACC^*

^* Oregon Health Sciences University, Portland, Oregon, USA
the Laboratory of Animal Medicine and Surgery, National Heart, Lung and Blood Institute, Bethesda, Maryland, USA
Freeman Hospital, Newcastle upon Tyne, United Kingdom

View larger version (27K): [in a new window]   Figure 1 The repaired tetralogy of Fallot model used in this in vitro model. See details in text. MPA = main pulmonary artery; PA = pulmonary artery; RVOT = right ventricular outflow tract.

View larger version (60K): [in a new window]   Figure 2 Examples of selected two-dimensional color Doppler images in the in vitro model. Image for measurement of forward stroke volume with flow coming towards the transducer in a horizontal plane corresponding to the major axis (top). Images for measurement of regurgitant stroke volume with flow going away from the transducer in a horizontal plane (middle) and in a paired orthogonal plane corresponding to the minor axis (bottom). The sampling rectangular box is below (or above) proximal to the flow convergence region for measuring the forward and regurgitant stroke volume. Note that the velocity profile of prestenotic flow is not flat, and the distance of velocity profile for regurgitant flow in the major axis is larger than it is in the minor axis.

View larger version (62K): [in a new window]   Figure 3 Examples of selected two-dimensional color Doppler images in the animal model. Images for measurement of forward stroke volume with flow going away from the transducer in an oblique outflow view corresponding to the horizontal plane (top left) and in a long axis view corresponding to the paired orthogonal plane (bottom left). Images for measurement of regurgitant volume with flow coming towards the transducer in the oblique outflow view (top right) and in the long axis view (bottom right) at the same diastolic phase. Note that the distance of the velocity profile for the RV forward flow in the oblique outflow view is larger than it is in the long axis view. Although the diameter of velocity profile for the regurgitant flow is similar, the shape of the velocity profile is different between two planes. AO = aorta; PA = pulmonary artery; RVOT = right ventricular outflow tract.

View larger version (26K): [in a new window]   Figure 4 Regression (A) and agreement (B) between regurgitant fractions by the DCD method and those by the flow meter in an in vitro study. In the major axis (A1 and B1), in the minor axis (A2 and B2) and using the average values from two orthogonal planes (A3 and B3). DCD = digital color Doppler.

View larger version (28K): [in a new window]   Figure 5 Regression (A) and agreement (B) between regurgitant fractions by the DCD method and references in an animal model. In the oblique outflow view (A1 and B1), in the long axis view (A2 and B2) and using average values from two orthogonal planes (A3 and B3). DCD = digital color Doppler; EM = electromagnetic flow.