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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

View larger version (84K): [in a new window]   Figure 1 Example of a color Doppler M-mode tracing (left) obtained through the flow convergence region as seen by the two-dimensional color Doppler image (right). The distance between the two first aliasing boundaries (interaliasing distance [IAD]) shown by the two arrows, is measured and the radius of the flow convergence zone mathematically derived (see text).

View larger version (16K): [in a new window]   Figure 2 Rationale and mathematical derivation of the flow convergence radius (Rcalc) using the interaliasing distance (IAD).

View larger version (16K): [in a new window]   Figure 3 Linear regression and analysis of agreement between mitral regurgitant stroke volume (MRV) derived from the measured radius (Rmeas) by using the conventional flow convergence (FC) method and electromagnetic (EM) flow probes and meters.

View larger version (16K): [in a new window]   Figure 4 Linear regression and analysis of agreement between mitral regurgitant stroke volume (MRV) derived from the calculated radius (Rcalc) by using the interaliasing distance (IAD) method and by electromagnetic (EM) flow probes and meters.

View larger version (22K): [in a new window]   Figure 5 Relative error ([calculated flow – actual flow)/actual flow] · 100) of both the interaliasing distance (Rcalc[IAD]) and conventional flow convergence (Rmeas[FC]) methods for estimating the flow rate depending on the distance to the orifice, which is expressed as normalized distance. The normalized distance equals to r/d, r being the radius of the flow convergence surface and d the diameter of the orifice (see text).

View larger version (10K): [in a new window]   Figure 6 Flow convergence (FC) region is theoretically composed of perfect hemispheres (left); however, because of the finite nature of the regurgitant orifice, progressive flattening of the isovelocity shells occurs as they approach the orifice (20) (right), leading to an increased distance between the first two aliasing boundaries (IAD).