ABSTRACT
The accuracy of continuous wave Doppler ultrasound in deriving pressure gradients across bioprosthetic heart valves was evaluated in an in vitro pulse duplicator. Simultaneous pressure transducer and Doppler measurements were made in new and explanted aortic bioprosthetic valves of several sizes and four types: Carpentier-Edwards, Ionescu-Shiley, Hancock standard and Hancock modified. The mean and peak gradients calculated by the modified Bernoulli equation from Doppler velocity measurements were always greater than those measured manometrically, despite corrections for location dependence of the manometric gradient (or pressure recovery). The relation between manometric and ultrasonically determined gradient was found to be statistically dependent on the valve type (mean gradient p less than 0.0001; peak gradient p = 0.0003) and size (mean gradient p = 0.0089; peak gradient p = 0.0107). Effects of implantation were observed, but were not shown to be significant. It is concluded that the continuous wave Doppler velocity data overestimated prosthetic valve pressure gradient in all cases, even when pressure recovery was taken into account. Clinicians should be wary of Doppler data when making major diagnostic or therapeutic decisions.
Subject(s)
Bioprosthesis , Echocardiography, Doppler , Heart Valve Prosthesis , Aortic Valve , Echocardiography, Doppler/standards , Evaluation Studies as Topic , Humans , Models, Cardiovascular , Models, Structural , Prosthesis Design , Signal Processing, Computer-Assisted , Transducers, PressureABSTRACT
A physiologic pulse duplicator for the simultaneous in-vitro hydrodynamic and ultrasonic evaluation of aortic prosthetic heart valves is described. The system is interfaced to a personal computer, which provides greater efficiency over manual techniques in system calibration, data acquisition, and analysis. The data analysis program aids selection of start and end systole and calculates pressure difference across the valve, the closing and regurgitant volumes, flow rates, and the Gabbay and Swanson performance indices. The pulse duplicator is designed to accommodate the ultrasonic measurement of fluid velocities, including pressure difference via the Bernoulli equation, and color-flow imaging. In tests of 19-mm, 23-mm, and 27-mm Bjork-Shiley spherical occluder valves, continuous-wave Doppler ultrasound was found to overestimate by about 50% the pressure difference measured directly by pressure transducers, a finding that is clinically important.