Doppler color flow mapping in the evaluation of prosthetic mitral and aortic valve function.

Doppler color flow mapping and color-guided conventional Doppler studies were performed on 119 patients with 126 prosthetic valves (mitral alone in 60, aortic alone in 52 and both mitral and aortic in 7 patients) within 2 weeks of the catheterization study or surgery, or both. The mean pressure gradients derived by color-guided continuous wave Doppler ultrasound correlated well with those obtained at catheterization for both the tissue and mechanical mitral and aortic prostheses (r = 0.85 to 0.87). For the effective prosthetic orifice areas, better correlation with catheterization results were obtained with the tissue mitral (r = 0.94) and tissue aortic (r = 0.87) prostheses than with the mechanical mitral (r = 0.79) and mechanical aortic (r = 0.76) prostheses. The maximal width of the color flow signals at their origin from the tissue mitral prostheses also correlated well with the effective prosthetic orifice area at catheterization (r = 0.81). Doppler color flow mapping identified prosthetic valvular regurgitation with a sensitivity and specificity of 89% and 100%, respectively, for the mitral and 92% and 83% for the aortic prostheses. There was complete agreement between the Doppler color flow mapping and angiographic grading of the severity of prosthetic valvular regurgitation in 90% of mitral and 73.5% of the aortic regurgitant prostheses with under- or overestimation by greater than 1 grade in only two cases. Valvular and paravalvular regurgitation was correctly categorized by Doppler color flow mapping in relation to the surgical findings in 94% of the mitral and 80.5% of the aortic prostheses.

Estimation of pulmonary artery pressure by colour guided continuous wave Doppler in cases of ventricular septal defect and tricuspid regurgitation.

The accuracy of a non-invasive estimation of systolic pulmonary artery pressure in 33 patients with ventricular septal defect and/or tricuspid regurgitation, by colour guided continuous wave Doppler was evaluated. The estimated pulmonary artery pressure correlated well with values obtained at cardiac catheterization (r = 0.93). Correlation was better in cases with ventricular septal defect (r = 0.98) than in cases with tricuspid regurgitation (r = 0.87). Pulmonary artery pressure was under-estimated in cases with mild tricuspid regurgitation, probably due to eccentricity of regurgitant jet in some of these cases.

Color Doppler evaluation of aortic dissection.

Color Doppler studies were performed in 16 adult patients with proven DeBakey type I and III aortic dissection. Simultaneous opacification of both aortic lumina with oppositely directed flow was noted by color Doppler in at least one aortic segment in 14 of 16 patients (12 type I, two type III). In two patients (one type I, one type III), flow was seen in one lumen only, with clot demonstrated in the other lumen in one of them. Of 12 patients in whom communication between two aortic dissection channels was shown by angiography/surgery, color Doppler correctly identified them in nine patients (four ascending aorta, two aortic arch, and three descending aorta), either by direct visualization of flow moving from one lumen into the other (six patients) or indirectly by analyzing differences in timing of opacification of the two lumina and flow direction (three patients). Also, color Doppler correctly diagnosed aortic regurgitation as severe (aortic regurgitation jet occupying more than 75% of left ventricular outflow) in three patients and moderate in four patients. Color Doppler provides comprehensive evaluation of flow dynamics in aortic dissection.

Color Doppler assessment of mitral regurgitation with orthogonal planes.

We evaluated 147 patients with adequate color Doppler and angiographic studies for mitral regurgitation. Sixty-five patients had no mitral regurgitation by both color Doppler and angiography and 82 patients had mitral regurgitation by both techniques. Thus the sensitivity and specificity of color Doppler for the detection of mitral regurgitation was 100%. Three two-dimensional echocardiographic planes (parasternal long and short axis, apical four-chamber view) were used to analyze variables of the mitral regurgitant jet signals in the left atrium. The best correlation with angiography was obtained when the regurgitant jet area (RJA) (maximum or average from three planes) expressed as a percentage of the left atrial area (LAA) obtained in the same plane as the maximum regurgitant area was considered. The maximum RJA/LAA was under 20% in 34 of 36 patients with angiographic grade I mitral regurgitation, between 20% and 40% in 17 of 18 patients with grade II mitral regurgitation, and over 40% in 26 of 28 patients with severe mitral regurgitation. Maximum RJA/LAA also correlated with angiographic regurgitant fractions (r = .78) obtained in 21 of 40 patients in normal sinus rhythm and with no evidence of associated aortic regurgitation. Other variables of the regurgitant jet such as maximal linear and transverse dimensions, maximal area, or maximal area expressed as a percentage of the LAA in one or two planes correlated less well with angiography. Color Doppler is a useful noninvasive technique that is not only highly sensitive and specific in the identification of mitral regurgitation but also provides accurate estimation of its severity.