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Flow-Dependent Changes in Doppler-Derived Aortic Valve Effective Orifice Area Are Real and Not Due to Artifact

Lyes Kadem, PhD, Eng^_*,, Régis Rieu, PhD^_*, Jean G. Dumesnil, MD, Louis-Gilles Durand, PhD, Eng and Philippe Pibarot, DVM, PhD^_*,_*

^_* Cardiovascular Biomechanics Team (IRPHE-CNRS), Université de la Méditerranée, Marseille, France
Biomedical Engineering Laboratory, Institut de recherches cliniques de Montréal, Montreal, Quebec, Canada
Research Center of Laval Hospital/Quebec Heart Institute, Laval University, Quebec, Canada

View larger version (20K): [in a new window]   Figure 1 Velocity field contours measured by particle image velocimetry downstream from the 1.5-cm2 rigid circular orifice at peak systole for a stroke volume of 20 ml (A) and 70 ml (B).

View larger version (9K): [in a new window]   Figure 2 Comparison between the effective orifice area (EOA) measured by Doppler (EOADop) and the EOA measured by particle image velocimetry (EOAPIV). (A) Correlation between EOADop and EOAPIV. The solid line is the regression line, and the dashed line is the identity line. (B) Bland-Altman plots of the difference between EOADop and EOAPIV as a function of EOAPIV. SEE = standard error of estimate.

View larger version (12K): [in a new window]   Figure 3 Effect of the variation in stroke volume on the effective orifice area (EOA) measured by Doppler and the EOA measured by particle image velocimetry (PIV) for the bioprosthetic valve (A) and the 1.5-cm2 (A), 1.0-cm2 (B), and 0.5-cm2 (B) rigid circular orifices.

View larger version (15K): [in a new window]   Figure 4 Comparison of the effective orifice area (EOA) measured by Doppler (or by catheter for the data of Voelker et al. [21]) (circles) and the EOA predicted from equation 4 (squares) for the 1.5-cm2 rigid circular orifice and the bioprosthetic valve tested in the present study (A), and for rigid circular orifices of 1.5 cm2 and 2.0 cm2 tested in vitro by Voelker et al. (21) (only transvalvular flow rate was provided in their study) (B). The horizontal doted line indicates the value of the EOA at the normal flow rate. The area in sparse hatchings represents the part of the change in EOA that is likely attributable to the unsteady effects, and the area in right hatchings likely represents the part that is attributable to the change in the geometric orifice area.