Detection of diastolic mitral regurgitation using pulsed Doppler and its implications.

Diastolic mitral regurgitation has been angiographically demonstrated in some patients with severe aortic regurgitation and/or nonobstructive cardiomyopathy. The purpose of this paper was two-fold: to study the feasibility of pulsed Doppler noninvasive detection of this unusually timed regurgitation on the basis of angiographic correlations in a group of 21 patients with such conditions and sinus rhythm with normal PR interval in 81% of the cases, and when diastolic mitral regurgitation was present, to study if it had clinical implications. Doppler detection was feasible in all cases and there were no false positive diagnoses. Comparison of haemodynamic data in patients without (group A) and with (group B) diastolic mitral regurgitation showed a significant increase in the mean values of pressures, particularly for the mean pulmonary artery and capillary wedge pressures (P less than 0.01 to 0.001), in group B. This study suggests that the recording of mitral flow velocity should be routinely performed in patients with such pathological conditions, since the finding of diastolic mitral regurgitation may have clinical significance.

A new non-invasive estimation of the stenotic aortic valve area by pulsed Doppler mapping.

A new pulsed Doppler mapping technique has been used to measure the severity of aortic valve stenosis. The Doppler examination was performed at the site of the aortic orifice in the parasternal short axis echocardiographic view and the method was based on the detection of the area of systolic flow through the stenotic orifice. This area was derived by planimetry and the measurements obtained by the Doppler method were compared with the aortic valve area calculated at catheterisation according to the Gorlin formula. The method was applicable in 41 of the 44 patients studied. The Doppler data were consistent with the haemodynamic measurements even in patients with decreased cardiac index. It is concluded that this new application of the flow mapping procedure is reliable and is easily applied to adult patients with a wide range of clinical conditions.

[Comparison of pulsed and continuous Doppler techniques for the evaluation of left ventricular stenoses]. / Comparaison des techniques Doppler pulsé et continu pour l'évaluation des sténoses valvulaires gauches.

The authors compared the data obtained with pulsed (pulsed Doppler-Scanner 3 MHz) and continuous wava Doppler (2.5 MHz), with that obtained by catheterisation in the evaluation of severity of valvular stenoses. The study material comprised 10 healthy subjects and 45 patients with mitral (21) and aortic (24 cases) stenosis, all of whom underwent catheterisation. Stenosis was graded in 3 degrees of increasing severity based on the catheter data. In addition, we studied the correlations between the transvalvular mitral and aortic pressure gradients, calculated by continuous Doppler and catheterisation, and the time of half decrease of flow measured by continuous Doppler and the mitral surface area calculated by catheterisation. No abnormality Was noted in the healthy patients. The jet of the aortic stenosis could not be recorded by continuous Doppler in 8 cases and aortic flow could not be recorded in 1 case with pulsed Doppler. The linear correlation with continuous Doppler was 0.96 (aortic transvalvular gradient for the 16 jets obtained), 0.81 (mitral transvalvular gradient), and 0.80 (time of half decrease of flow and mitral surface area calculated with catheterisation). The comparative study of the degree of severity gives the following percentages of success: mitral stenosis, 85% (pulsed Doppler) vs 71% (continuous Doppler) for mitral stenoses; aortic stenoses 83% (pulsed Doppler) vs 58% (continuous Doppler). In the 16 cases where the aortic jet was recorded properly this percentage was 87% (continuous Doppler) vs 81% (pulsed Doppler). In conclusion, the advantage of continuous Doppler over pulsed Doppler is that it provides quantitative parameters in correlation with catheter data. It is mainly used for evaluating recording the jet should significantly suggest that in elderly patients a systematic right parasternal approach in the jet should significantly reduce the failure rate observed in this study. It is of more limited value in mitral stenoses where pulsed Doppler gives more detailed information about the flow through the mitral valve. This, and the fact that pulsed Doppler can also be used for assession of aortic stenoses, illustrate the complementary nature of the two technique which should always be used together.