We studied 44 consecutive patients (21 men and 23 women (mean age 58)) with aortic stenosis who underwent left heart catheterisation. Forty two patients were in sinus rhythm and two were in atrial fibrillation. The aetiology was congenital (2
2D echo-Doppler flow mapping was applied to regurgitations due to mitral valve prolapse, acccording to
a methodology previously described for mitral regurgitation of various origins. The study involved 34 patients with
37 prolapses, all invasively confirmed. Three important orders of information were successfully provided by this
procedure. (1) The presence of flow anomalies was diagnostic, with sensitivity and specificity ranging between 91 and
93 % of cases, respectively. (2) The three-dimensional spreading of the flow anomalies was used to calculate indices of
severity which enabled a classification of severity on a three-grade scale. Correlations with invasive procedures were
satisfactory in 87% of the diagnosed cases. (3) More specifically, the site of the flow anomalies and atrial location of
the regurgitation led to predict which was the involved leaflet, which part of it was regurgitant, and the presence and
site of eventual chordae ruptures, with a percentage of satisfactory correlations ranging between 86 and 100% of
cases. All three orders of information appear of conspicuous value for the management of these patients, particularly
in view of eventual reconstructive surgery.
The purpose of the flow mapping procedure is to pick up flow signals related to jets at the site of lesions, in order to delineate the cross-section of the jets. The pulsed Doppler procedure was applied to a group of 33 consecutive patients with mitral stenosis confirmed invasively in all cases and by surgery in 15 cases. The examination involved the recording of flow signals at the distal edge of the mitral oriface investigated in the short-axis view. Doppler criteria for required flow signals were the presence of a high-pitched tone and of a laminar spectrum, occurring at a definite timing in early to mid-diastole, i.e. at the period of the maximal atrioventricular pressure gradient. Planimetry of the flow area was performed and correlated with haemodynamic data using the Gorlin formula. The procedure was applicable in 32/33 patients. The correlation coefficient was 0.94, standard error of estimate 0.13 cm2, P less than 0.001. The mean difference between invasive and non-invasive measurements was -0.04 +/- 0.14 cm2 and the standard error of the mean 0.03 cm2. This new application of flow mapping provided reliable information for the later surgical procedure. It should benefit in future from improvements in spatial resolution and in signal to noise ratio.
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