A comparison of the assessment of mitral valve area by continuous wave Doppler and by cross sectional echocardiography (original) (raw)
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European Heart Journal, 1981
Diastolic separation of mitral leaflets (DSML) on the M-mode echocardiogram as an index for the quantitative estimation of mitral stenosis, was measured in 30 patients with rheumatic mixed mitral valve disease, who subsequently underwent valve replacement. It correlated highly significantly with the mitral valve orifice area, measured on the excised valves by means of a sizer set to detect area differences up to frl cm 2 (r=(r76, P < (rOOl). In the subgroup of 15 patients who also underwent two-dimensional echocardiographic examination, the correlation between DSML and anatomical area had a higher statistical significance (P < (rOOl) than the comparison between the area measured using two-dimensional echocardiography and the anatomical area (P < &01). These results indicate that the index we propose allows an estimate of real mitral valve orifice area which is highly reliable and has a comparable or even lower error probability than direct measurement using two-dimensional echocardiography. M-mode echocardiography has proved to be a have diminished interest in the assessment of mitral reliable method for the detection of rheumatic valve disease by the M-mode technique. As a mitral valve disease, but its value in predicting the matter of fact, a two-dimensional short axis image degree of stenosis seems to be rather limited, of the mitral valve allows a direct appreciation of Several investigators have found a positive linear the degree of stenosis and several studies have correlation between the reduction of the early confirmed its value in clinical practice! 1 *-16 ]; even diastolic closing rate of the anterior mitral valve more recently, however, the potential limitations of leaflet (i.e. the E-F slope) and the mitral valve this technique have been pointed out, limitations orifice area, either calculated during cardiac caused by technical factors and by the morphocatheterization using the Gorlin formulai'l, or logical characteristics of the valve itself I 17 J. measured anatomically at surgery! 2 " 6 ]. The reduc-Two-dimensional echocardiography, moreover, tion of the E-F slope, however, is not a specific is more expensive than M-mode examination, and criterion, since it is present also in diseases that do it requires more time for its execution and subnot affect the mitral valvel 7 " 11 !, and it is influenced sequent analysis. The search for a reliable index for by factors other than the valve area reduction. Thus the quantitative evaluation of mitral valve disease, its reliability as an index of the severity of the using M-mode echocardiography, remains theremitral stenosis has been questionedl |2>IJ J. fore an open question, which deserves further The application in clinical practice of the two-investigation, dimensional echocardiographic technique seems to
Doppler echocardiographic estimation of mitral valve area during changing hemodynamic conditions
The American Journal of Cardiology, 1991
Patients with mitral stenosis often present during periods of hemodynamic stress such as pregnancy or infections. The Doppler pressure halftime method of mitral valve area (MVA) determination is dependent on the net atrioventricular compliance as well as the peak transmitral gradient. The continuity equation method of MVA determination is based on conservation of mass and may be less sensitive to changes in the hemodynamic state. To test this hypothesis, 17 patients admitted for catheterization with symptomatic mitral stenosis and no more than mild regurgitation underwent Doppler echocardiography at rest and during supine bicycle exercise targeted to an increase in heart rate by 20 to 30 beats/minute. Net atrioventricular compliance was also estimated noninvasively. Cardiac output and transmitral gradient increased significantly during exercise (p <O.OOl), while net atrioventricular compliance decreased (p <O.OOl). MVA by the pressure half-time method increased significantly during exercise from 1.0 f 0.2 to 1.4 f 0.4 cm* (p <O.OOl). There was no significant difference in MVA estimation using the continuity equation comparing rest to exercise, with the mean area remaining constant at 0.8 f 0.3 cm* (p = 0.83). Thus, during conditions of changing hemodynamics, the continuity equation method for estimating MVA may be preferable to the pressure half-time method.
Indonesian Journal of Cardiology
Background: Rheumatic mitral stenosis (RMS) is the cause of mitral valve disease commonly found in developing countries. Determining severity of RMS is very important, related with prognosis and management of the disease. Current echocardiography methods have advantages and disadvantages in determining the severity of RMS. Posterior to anterior mitral valve leaflets length ratio (PMVL/ AMVL ratio) was proposed to be one of the semi-quantitative measurement which offered a simple, easy and accurate method in determining the severity of RMS. The aim of this study was to see the association of posterior to anterior mitral valve leaflets length ratio with severity of rheumatic mitral stenosis. Methods: This was a cross-sectional descriptive analytic study. The subjects were all patients with rheumatic mitral stenosis who underwent echocardiography examination to measure the PMVL/AMVL ratio as well as determining the severity based on mitral valve area (MVA) planimetry. One-way ANOVA analytic test was used to assess the association of ratio PMVL/AMVL and severity of the RMS. Results: Of 71 patients included in this study, there were 19 mild RMS, 19 moderate RMS and 33 severe RMS patients. Majority of the subjects were female with age range from 38 to 43 years and have atrial fibrillation. From echocardiography examination, the mean EF +/-55% with increased LAVI and SPAP according to the severity of the RMS (LAVI; 44±1.3 vs. 55±1.5 vs. 74±1.7 ml/m 2 SPAP; 29±1.2 vs. 46±9.0 vs. 68±1.4 mmHg). There was a significant difference in the length of PMVL in mild, moderate and severe RMS (28±5.6 vs. 22±4.0 vs. 17±5.2 mm; p<0.001), but no significant difference in the length of AMVL (33±5.5 vs 33±5.4 vs 32±5.1mm; p=0.93) respectively. The PMVL/AMVL ratio had statistically significant association with severity of RMS (p<0.001). Conclusion: The PMVL/AMVL ratio is significantly associated with severity of RMS.
Anatomical and Hemodynamic Evaluation of Mitral Stenosis Patients with Echocardiography
Bioscientia Medicina : Journal of Biomedicine and Translational Research
Mitral stenosis (MS) is the most common valvular heart disease encountered in developing countries. The cause of MS is almost always chronic rheumatic heart disease. Echocardiography is the single most important diagnostic tool in the evaluation of MS. The objectives are to confirm the etiology, to assess the severity of stenosis, to recommend the type and timing of intervention, to assess other valvular lesions, presence of thrombus, and vegetation. According to current guidelines and recommendations for clinical practice, the severity of MS should not be defined by a single value but rather be assessed by a multimodality approach that determines valve areas, mean Doppler gradients, and pulmonary arterial pressures. The European Society of Echocardiography/American Society of Echocardiography (EAE/ASE) recommendations of measurement method for clinical practice were categorized into three level of recommendations. Mitral valve area (MVA) can be assessed by planimetry using either 2...
The assessment of mitral valve disease: a guideline from the British Society of Echocardiography
Echo Research and Practice
Mitral valve disease is common. Mitral regurgitation is the second most frequent indication for valve surgery in Europe and despite the decline of rheumatic fever in Western societies, mitral stenosis of any aetiology is a regular finding in all echo departments. Mitral valve disease is, therefore, one of the most common pathologies encountered by echocardiographers, as both a primary indication for echocardiography and a secondary finding when investigating other cardiovascular disease processes. Transthoracic, transoesophageal and exercise stress echocardiography play a crucial role in the assessment of mitral valve disease and are essential to identifying the aetiology, mechanism and severity of disease, and for helping to determine the appropriate timing and method of intervention. This guideline from the British Society of Echocardiography (BSE) describes the assessment of mitral regurgitation and mitral stenosis, and replaces previous BSE guidelines that describe the echocardi...
Quantitative study of the mitral valve in chronic rheumatic heart disease
International Journal of Cardiology, 1987
HL. Quantitative study of the mitral valve in chronic rheumatic heart disease. Int J Cardiol 1987;16:271-284. A quantitative study of the mitral valve and its tension apparatus was carried out in 54 cases of pure mitral stenosis, 13 cases of mitral stenosis with incompetence, both diseased groups due to rheumatism, and 25 normals. In the group with pure mitral stenosis, the annular size was unaltered but the annular attachment of the mural leaflet was decreased. The average circumference of the orifice was 27 mm. The leaflet length increased by 24%. In the group with mitral stenosis with incompetence, the annular size was increased by 18%. The average circumference of the orifice was 39 mm, but no significant increase in the length of the leaflets was found. The rough zone of the aortic leaflet in pure mitral stenosis is disproportionately increased, indicating greater apposition during closure. In pure mitral stenosis, the cords were severely affected as compared to combined lesion. They were totally absent in 18.5% of cases while this lesion was restricted to the aortic leaflet in 37%. The commissural, paracommissural and paramedial cords were not seen in 75, 60, and 72%. The main cords were not seen in 50% of cases. In the combined lesion, cords attached to the aortic leaflet only were absent in 7.69%. The commissural, paracommissural and paramedial cords were absent in 33, 39, and 23%, respectively. The main cords were absent in only 19%. The reduction in lengths of the cords is more marked in cases with pure stenosis. We conclude that the mitral valve is better preserved in the group having stenosis with incompetence, the incompetence being the result of a larger annulus and orifice with normal leaflets and shorter tendinous cords. In pure mitral stenosis, the incompetence through a small orifice is prevented by the longer leaflets, particularly the aortic.
Journal of the American College of Cardiology, 1989
Estimation of the orifice area is of major importance in the timing of valve dilation or surgery in patients with mitral stenosis. Determination of the area has traditionally been accomplished at cardiac catheterization by the Gorlin equation. The valve area can also be estimated noninvasively with Doppler echocardiographic measurements of the pressure half-time, which is inversely proportional to the area. This method has gained widespread acceptance, but its accuracy has recently been questioned and factors other than reduction of orifice area appear to modify the pressure half-time. In the present study, the influence of left ventricular stiffness (defined as diastolic pressure rise per milliliter of mitral flow) and peak atrioventricular pressure difference on the pressure half-time was examined both in a hydraulic model and by review of data from 35 patients with mitral stenosis. Left ventricular stiffness <0.13 mm Hglml was considered normal.
Echocardiographic evaluation of mitral valve in patients with pure rheumatic mitral regurgitation
Atalay S, Uçar T, Özçelik N, Ekici F, Tutar E. Echocardiographic evaluation of mitral valve in patients with pure rheumatic mitral regurgitation. Turk J Pediatr 2007; 49: 148-153. The aims of this study were to evaluate the structure of the mitral valve (MV) and subvalvar apparatus in patients with rheumatic mitral regurgitation (MR) by echocardiography and to compare the differences in morphologic abnormalities between subgroups of patients with and without mitral valve prolapse (MVP). Two-dimensional and color Doppler echocardiographic examinations were performed in 20 consecutive patients with isolated rheumatic MR and in 15 healthy subjects as controls. Annular diameter, left ventricular end-diastolic dimension, anterior leaflet length, and both leaflet thicknesses were greater in MR than those of controls. Anterior leaflet and chordal lengths were greater in severe MR than in mild or moderate MR. Sixty percent of rheumatic MR patients had nodules on the body or tip of the anterior mitral leaflet and MR was more severe in these patients. Nine of 20 patients (45%) had MVP. MR was more severe in the patients with MVP than those without prolapse. Rheumatic etiology should be suspected in patients with MR when irregular focal thickening of MV, relatively immobile posterior leaflet, eccentric regurgitant jet, and anterior MVP are found in echocardiographic study.
The American Journal of Cardiology, 1991
Doppler echocardiography has been widely used as a noninvasive method to quantify valvular heart diseases. This study assessed the variability between 2 echocardiography centers concerning P-dimensional and Doppler echocardiographic results in the quantification of mitral and aortic valve stenoses. Forty-two patients were studied by 2 different echocardiography centers in a blinded, independent fashion. In patients with aortic and mitral valve stenosis, mean and maximal flow velocities were measured. The aortic valve orifke area was calculated according to the continuity equation. Mitral valve orifice area was determined by direct planimetry and by pressure half-time. In patients with an aortic valve stenosis, a close relation between the 2 centers was found for the maximal and mean flow velocities (coefficient of correlation, r = 0.72 to 0.92; coefficient of variation, 3.7 to 7.7%). A close correlation and a small observer variability was found for the flow velocity ratio determined by flow velocities measured in the left ventrkular outflow tract and over the stenotic valve (r = 0.88, coefficient of variation, 0.01 f 0.00s). In contrast, there was a poor correlation between the diameter of the left ventricular outflow tract and the aortic orifice area (r = 0.36 and 0.59, respectively). In patients with a mitral valve stenosis, mean and maximal velocities were closely correlated (r = 0.66 and 0.77, respectlvely). Velocities were not found to be significantly different between the 2 centers. Vari-From the Universit8tsklinik Freiburg, Junere Medizin III, Federal Republic of Germany, and Rehabilitationszentrm Bad Krozingen, Federal Republic of Germany.