Dynamic nature of the aortic regurgitant orifice area during diastole in patients with chronic aortic regurgitation.

Reimold, Sharon C.; Maier, Stephan E.; Fleischmann, Kirsten E.; Khatri, Mohammed; Piwnica‐Worms, David; Kikinis, Ron; Lee, Richard T.

doi:10.1161/01.cir.89.5.2085

Cited by 19 publications

(13 citation statements)

References 28 publications

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“…Impaired forward stroke volume yields a decreased systolic pressure and a narrow pulse pressure. 12,13 Although there is some degree of compensation by a Frank-Starling mechanism, the ventricle is functioning on a steep pressure-volume curve because of the lack of chamber dilation. This contrasts with chronic regurgitation, in which end-diastolic pressures are relatively low, and the additional stroke volume manifests as an increased systolic pressure (Table 2).…”

Section: Aortic Valve Regurgitationmentioning

confidence: 99%

Acute Valvular Regurgitation

2009

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Section: Aortic Valve Regurgitationmentioning

confidence: 99%

Acute Valvular Regurgitation

2009

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“…9 Furthermore, aortic pressure dependence of the orifice area has also been demonstrated in an in vitro model, 10 and changes of orifice area during diastole were observed in patients with chronic aortic regurgitation. 15 These observations suggest that dynamic alteration of the orifice may be a mechanism whereby vasodilator treatment reduces regurgitant volume and left ventricular volume. This is plausible because it is difficult in practice to reduce diastolic blood pressure significantly in patients with chronic aortic regurgitation, as they already have low diastolic pressures.…”

Section: Discussionmentioning

confidence: 93%

“…16 However, we did not observe any relation between percentage change in aortic pressure and orifice area, which is consistent with a previous report in patients with chronic aortic regurgitation. 15 The apparent inconsistency of these findings probably reflects the differences between acute and chronic animal models. In chronic aortic regurgitation, left ventricular systolic function, left ventricular volume, and left ventricular and aortic compliance vary substantially in animal models, depending on the severity and duration of the aortic regurgitation.…”

Section: Discussionmentioning

confidence: 99%

Effect of load alterations on the effective regurgitant orifice area in chronic aortic regurgitation

Jones

Shiota

Tsujino

et al. 2002

Heart

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Objective: To evaluate the load dependence of effective regurgitant orifice area (ROA) in an animal model of chronic aortic regurgitation. Methods: Eight sheep were studied 10-20 weeks after the surgical creation of aortic regurgitation. After baseline studies, 500 ml of blood, angiotensin II, and nitroprusside were infused sequentially. Electromagnetic flow meters were used as reference standards to determine aortic regurgitation volume. The time-velocity integral was acquired using the continuous wave Doppler method. Results: Baseline aortic regurgitant volume varied from 8 ml (regurgitant fraction 28%) to 29 ml (59%), with a mean (SD) value of 17 (8)

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“…In patients with 1. unsatisfactory ultrasound windows, 2. with equivocal findings, and 3. in cases with contradictory results (e. g. mild regurgitation and severe left ventricular dysfunction) MR may be considered as the method of choice for further evaluation [57]. By means of PC-MR flow measurements through the aortic root, anterograde and retrograde blood flow during the cardiac cycle is quantified and provides accurate measures of regurgitant volume and regurgitant fraction [10,19,38,52]. Walker et al…”

Section: Assessment Of Lesion Severitymentioning

confidence: 99%

Valvular Heart Disease: Assessment of Valve Morphology and Quantification Using MR

Schwitter

2000

Herz

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For clinical evaluation and decision-making in patients with valvular heart disease, the diagnostic armamentarium expands steadily. This evolution makes it difficult to choose the most appropriate approach for a specific valvular lesion. It may also reflect our uncertainty of what are the findings that best predict clinical outcome of patients, e.g. after surgery. Accordingly, for each type of valvular lesion, some pathopysiological considerations are stated in order to derive the most important measures that would allow optimal guidance of patients. Based on these considerations the value of an MR study is discussed for each valvular lesion. Newest advances in MR technology allow for highly accurate measurements of regurgitant volumes and hence, MR may be the method of choice for a quantitative evaluation of regurgitant valves. For assessment of stenosis severity, measurement of transvalvular pressure gradient is an appropriate measure and MR may not confer benefits over echocardiography, provided the ultrasound window is adequate (and stroke volume is in the normal range). With respect to surgical treatment, valvular morphology is of pivotal importance, particularly for the mitral valve, and echocardiography still appears to be the first line method. Little data relate lesion severity and/or morphology to clinical outcome. Conversely, the extent of cardiac adaptation to pressure- and/or volume-overload, i.e. ventricular remodeling, is a strong predictor of outcome, and is therefore most important for final judgement of the patient. For assessment of left and right ventricular remodeling, echocardiography typically provides all the necessary information. However, in special cases with discrepant findings, with inadequate ultrasound window, or in the preoperative work-up, MR may provide important information regarding cardiac adaptation to valvular lesion.

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Dynamic nature of the aortic regurgitant orifice area during diastole in patients with chronic aortic regurgitation.

Abstract: The effective regurgitant orifice area decreases during diastole in patients with chronic aortic regurgitation. This phenomenon should be considered when evaluating aortic regurgitant severity.

Cited by 19 publications

References 28 publications

Acute Valvular Regurgitation

Acute Valvular Regurgitation

Effect of load alterations on the effective regurgitant orifice area in chronic aortic regurgitation

Valvular Heart Disease: Assessment of Valve Morphology and Quantification Using MR

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