title: Determination of regurgitant flow and volume by integrating actual proximal velocities over hemispheres (IPROV) in two orthogonal planes.
abstract: The proximal acceleration technique is a promising technique for quantification of regurgitant valve flow. Although the shape of the regurgitant proximal isovelocity field has been shown to vary with orifice size, geometry, and driving pressure, normally the centerline velocity alone is used for estimation of flow. In this model study of pulsatile flow, two-dimensional and spectral Doppler data were transferred digitally to a computer in which proximal velocity fields were corrected for time and angle errors. With the purpose of improving accuracy, flow was estimated by integrating proximal velocities over nonisovelocity spheric control surfaces in the best zone of measurement (0.15 to 0.45 m/sec at an angle up to +/- 45 degrees from the center line) in two perpendicular planes. Three regurgitant volumes in the range of 5 to 21 ml were studied for circular (diameters of 4, 6, and 8 mm), crescent, and diagonal orifices. The quotient between effective orifice area, estimated by dividing peak flow with peak velocity in the vena contracta, and true orifice area (Aeff = Q(tm)/Vo(tm)) was 0.66 (range 0.60 to 0.79), 0.50 (0.48 to 0.52), and 0.67 (0.66 to 0.68) for the circular, crescent, and diagonal orifices, respectively. Regurgitant volume estimated by multiplying effective orifice area by the velocity-time integral in the vena contracta (V = Aeff.velocity-time integral) ranged from 92% to 115% of the true volume for the circular, 89% to 92% for the crescent, and 105% to 112% for the diagonal orifices, respectively. It is possible to calculate regurgitant volume correctly with data acquisition from multiple hemispheres and planes and postprocessing of data. This amendment of the proximal acceleration technique has great advantage over the center-line method, especially when the orifice is asymmetric.
authors.affiliation: Department of Biomedical Engineering, University of Linköping, Sweden.
authors.forename: L
authors.initials: L
authors.lastname: Eidenvall
authors.forename: D
authors.initials: D
authors.lastname: Loyd
authors.forename: B
authors.initials: B
authors.lastname: Wranne
authors.forename: P
authors.initials: P
authors.lastname: Ask
mesh_terms: D001783:Blood Flow Velocity; D018618:Echocardiography, Doppler, Color / Q000379:methods*; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging*; D006801:Humans; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging; D008955:Models, Cardiovascular; D011673:Pulsatile Flow