title: Echo-Doppler angle determination for noninvasive transmitral blood velocity calculations in normal and porcine bioprosthetic mitral valves.
abstract: Doppler incident angle (DA) determination is a critical factor in the noninvasive attempt to measure transmitral blood velocity (TMBV) and to estimate volumetric flow. The error in TMBV varies with the cosine of DA. Using an echo-Doppler duplex scanner (DS), we studied transmitral flow velocities in 10 normal subjects (Group I) and 10 asymptomatic patients with procine mitral valve (PMV) bioprostheses. A 3-MHz scanhead with three medium focused rotating transducers was positioned at the left ventricular apex, and standard apical four-chamber views of the heart were obtained. The position of the Doppler sample volume (SV) was adjusted within the valve orifice until the maximal power of the Doppler audio spectra reflecting TMBV was recorded by a spectral analyzer. At this location of the SV, images were recorded and protractors were used to estimate DA. DA ranged from 10 to 40 degrees (x = 22.5 degrees +/- 10.8 degrees) in Group I and from 0 to 15 degrees (x = 4.5 degrees +/- 5.0 degrees) in Group II. Mean values of DA in Groups I and II were significantly different (p less than 0.01). We conclude: (1) in normal subjects, DA measured from the apex into the MV varies significantly and thus may compromise the accuracy of TMBV measurements; (2) the truncated funnel shape of the stent of the PMV bioprosthesis allows a DA less than 15 degrees and thus a smaller error in TMBV calculations.
mesh_terms: D000328:Adult; D001705:Bioprosthesis; D001783:Blood Flow Velocity; D005260:Female; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000502:physiology*; D014465:Ultrasonics / Q000295:instrumentation*