title: Dynamic change in mitral regurgitant orifice area: comparison of color Doppler echocardiographic and electromagnetic flowmeter-based methods in a chronic animal model.
abstract: OBJECTIVE
  The aim of the present study was to investigate dynamic changes in the mitral regurgitant orifice using electromagnetic flow probes and flowmeters and the color Doppler flow convergence method.
  
  
  BACKGROUND
  Methods for determining mitral regurgitant orifice areas have been described using flow convergence imaging with a hemispheric isovelocity surface assumption. However, the shape of flow convergence isovelocity surfaces depends on many factors that change during regurgitation.
  
  
  METHODS
  In seven sheep with surgically created mitral regurgitation, 18 hemodynamic states were studied. The aliasing distances of flow convergence were measured at 10 sequential points using two ranges of aliasing velocities (0.20 to 0.32 and 0.56 to 0.72 m/s), and instantaneous flow rates were calculated using the hemispheric assumption. Instantaneous regurgitant areas were determined from the regurgitant flow rates obtained from both electromagnetic flowmeters and flow convergence divided by the corresponding continuous wave velocities.
  
  
  RESULTS
  The regurgitant orifice sizes obtained using the electromagnetic flow method usually increased to maximal size in early to midsystole and then decreased in late systole. Patterns of dynamic changes in orifice area obtained by flow convergence were not the same as those delineated by the electromagnetic flow method. Time-averaged regurgitant orifice areas obtained by flow convergence using lower aliasing velocities overestimated the areas obtained by the electromagnetic flow method ([mean +/- SD] 0.27 +/- 0.14 vs. 0.12 +/- 0.06 cm2, p < 0.001), whereas flow convergence, using higher aliasing velocities, estimated the reference areas more reliably (0.15 +/- 0.06 cm2).
  
  
  CONCLUSIONS
  The electromagnetic flow method studies uniformly demonstrated dynamic change in mitral regurgitant orifice area and suggested limitations of the flow convergence method.
authors.affiliation: Clinical Care Center for Congenital Heart Disease, Oregon Health Sciences University, Portland, USA.
authors.forename: T
authors.initials: T
authors.lastname: Shiota
authors.forename: M
authors.initials: M
authors.lastname: Jones
authors.forename: D E
authors.initials: DE
authors.lastname: Teien
authors.forename: I
authors.initials: I
authors.lastname: Yamada
authors.forename: A
authors.initials: A
authors.lastname: Passafini
authors.forename: S
authors.initials: S
authors.lastname: Ge
authors.forename: D J
authors.initials: DJ
authors.lastname: Sahn
mesh_terms: D000818:Animals; D001783:Blood Flow Velocity; D006328:Cardiac Catheterization; D015986:Confounding Factors, Epidemiologic; D003326:Coronary Circulation; D004195:Disease Models, Animal; D018618:Echocardiography, Doppler, Color; D055590:Electromagnetic Phenomena; D018056:Hemorheology; D016014:Linear Models; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D012756:Sheep