title: Validation of a digital color Doppler flow measurement method for pulmonary regurgitant volumes and regurgitant fractions in an in vitro model and in a chronic animal model of postoperative repaired tetralogy of Fallot.
abstract: OBJECTIVE
  The purpose of this study was to validate a digital color Doppler (DCD) automated cardiac flow measurement method for quantifying pulmonary regurgitation (PR) in an in vitro and a chronic animal model of the right ventricular outflow tract of postoperative tetralogy of Fallot (TOF).
  
  
  BACKGROUND
  There has been no reliable ultrasound method that can accurately quantitate PR.
  
  
  METHODS
  We developed an in vitro model of mild pulmonary stenosis and wide-open PR that mimics the patterns of flow seen in patients with postoperative TOF. Thirteen different forward and regurgitant stroke volumes (RSVs) across the noncircular shaped cross-sectional outflow tract flow area were estimated using the DCD method in two orthogonal planes. In six sheep with surgically created PR, 24 different hemodynamic states with PR strictly quantified by electromagnetic probes were also studied.
  
  
  RESULTS
  The RSVs and regurgitant fractions (RFs) obtained by the DCD method using average values from two orthogonal planes correlated well with reference values (RSV: r = 0.99, mean difference = 0.02 +/- 0.39 ml/beat for in vitro model; r = 0.97, mean differences = 1.79 +/- 1.84 ml/beat for animal model, RF: r = 0.98, mean difference = -1.10 +/- 4.34% for in vitro model; r = 0.94, mean difference = 2.73 +/- 6.75% for animal model). However, the DCD method using a single plane had limited accuracy for estimating pulmonary RFs and RSVs.
  
  
  CONCLUSIONS
  The DCD method using average values from two orthogonal planes provides accurate estimation of RSVs and RFs and should have clinical importance for serially quantifying PR in patients with postoperative TOF.
authors.affiliation: Oregon Health Sciences University, Portland, USA.
authors.forename: Y
authors.initials: Y
authors.lastname: Mori
authors.forename: T
authors.initials: T
authors.lastname: Irvine
authors.forename: M
authors.initials: M
authors.lastname: Jones
authors.forename: R A
authors.initials: RA
authors.lastname: Rusk
authors.forename: Q
authors.initials: Q
authors.lastname: Pham
authors.forename: A
authors.initials: A
authors.lastname: Kenny
authors.forename: D J
authors.initials: DJ
authors.lastname: Sahn
mesh_terms: D000818:Animals; D001810:Blood Volume / Q000502:physiology*; D007091:Image Processing, Computer-Assisted; D066298:In Vitro Techniques; D008955:Models, Cardiovascular; D019047:Phantoms, Imaging; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D011665:Pulmonary Valve Insufficiency / Q000000981:diagnostic imaging*; D015203:Reproducibility of Results; D012756:Sheep; D013771:Tetralogy of Fallot / Q000000981:diagnostic imaging / Q000601:surgery*; D014463:Ultrasonography