Doppler Measurement of Cardiac Output Across Prosthetic Mitral Valves

Overview

Journal Klin Wochenschr

Specialty General Medicine

Date 1990 Mar 5

PMID 2325355

Authors

H Dittmann

W Voelker

K R Karsch

L Seipel

Affiliations

Soon will be listed here.

Abstract

In 46 patients with a normal functioning mitral valve prosthesis (15 St. Jude, 19 Medtronic Hall, 12 Hancock) cardiac output was measured by pulsed Doppler echocardiography across the valve prosthesis. Simultaneously cardiac output was determined by thermodilution or pulsed Doppler echocardiography in the left ventricular outflow tract (2.8 l/min-9.5 l/min). The prosthetic valve area was calculated using the pressure half-time method. Cardiac output was calculated by multiplying time-velocity integrals with the mitral valve area. Cardiac output measurements across the mitral prosthesis correlated significantly with thermodilution (r = 0.96, SEE = 0.400 l/min) and pulsed Doppler echocardiography flow measurements in the left ventricular outflow tract (r = 0.82, SEE = 0.679 l/min). The mean percent error of the Doppler transmitral flow measurement was 10.8%. Doppler transmitral flow underestimated cardiac output valves of more than 6.5 l/min in 6 of 7 patients. Cardiac output measurements across Hancock (SEE = 0.473 l/min) and St. Jude prostheses (SEE = 0.538 l/min) were more accurate than across Medtronic Hall prostheses (SEE = 0.847 l/min). Cardiac output can be calculated by pulsed Doppler echocardiography across normal functioning mitral prostheses. Due to the different flow dynamics the accuracy of cardiac output measurement depends on the prosthetic valve type. Reliable measurements of cardiac output can be performed across Hancock and St. Jude prostheses only. This method is limited in volume flow measurements across Medtronic Hall prostheses.

References

Panidis I, Ross J, Mintz G . Normal and abnormal prosthetic valve function as assessed by Doppler echocardiography. J Am Coll Cardiol. 1986; 8(2):317-26. DOI: 10.1016/s0735-1097(86)80046-8. View

Bruss K, Reul H, van Gilse J, Knott E . Pressure drop and velocity fields at four mechanical heart valve prostheses: Björk-Shiley Standard, Björk-Shiley Concave-Convex, Hall-Kaster and St. Jude Medical. Life Support Syst. 1983; 1(1):3-22. View

Wranne B, Ask P, Loyd D . Problems related to the assessment of fluid velocity and volume flow in valve regurgitation using ultrasound Doppler technique. Eur Heart J. 1987; 8 Suppl C:29-33. DOI: 10.1093/eurheartj/8.suppl_c.29. View

Thomas J, Weyman A . Doppler mitral pressure half-time: a clinical tool in search of theoretical justification. J Am Coll Cardiol. 1987; 10(4):923-9. DOI: 10.1016/s0735-1097(87)80290-5. View

Williams G, Labovitz A . Doppler hemodynamic evaluation of prosthetic (Starr-Edwards and Björk-Shiley) and bioprosthetic (Hancock and Carpentier-Edwards) cardiac valves. Am J Cardiol. 1985; 56(4):325-32. DOI: 10.1016/0002-9149(85)90858-6. View

Yoganathan A, Chaux A, Gray R, Woo Y, DeRobertis M, Williams F . Bileaflet, tilting disc and porcine aortic valve substitutes: in vitro hydrodynamic characteristics. J Am Coll Cardiol. 1984; 3(2 Pt 1):313-20. DOI: 10.1016/s0735-1097(84)80014-5. View

Schramm D, Baldauf W, Meisner H . Flow pattern and velocity field distal to human aortic and artificial heart valves as measured simultaneously by ultramicroscope anemometry in cylindrical glass tubes. Thorac Cardiovasc Surg. 1980; 28(2):133-40. DOI: 10.1055/s-2007-1022064. View

Wilkins G, Gillam L, Kritzer G, Levine R, Palacios I, Weyman A . Validation of continuous-wave Doppler echocardiographic measurements of mitral and tricuspid prosthetic valve gradients: a simultaneous Doppler-catheter study. Circulation. 1986; 74(4):786-95. DOI: 10.1161/01.cir.74.4.786. View

Curtius J, Pawelzik H, Mittmann B, Breuer H, LOOGEN F . [Doppler echocardiography normal values in various types of mitral valve prostheses]. Z Kardiol. 1987; 76(1):25-9. View

10.

Holen J, Hie J, Semb B . Obstructic characteristics of Björk-Shiley, Hancock, and Lillehei-Kaster prosthetic mitral valves in the immediate postoperative period. Acta Med Scand. 1978; 204(1-2):5-10. DOI: 10.1111/j.0954-6820.1978.tb08389.x. View

11.

Meijboom E, Horowitz S, Sahn D, Larson D, Oliveira Lima C . A Doppler echocardiographic method for calculating volume flow across the tricuspid valve: correlative laboratory and clinical studies. Circulation. 1985; 71(3):551-6. DOI: 10.1161/01.cir.71.3.551. View

12.

Goldberg S, Sahn D, ALLEN H, Hoenecke H, Carnahan Y . Evaluation of pulmonary and systemic blood flow by 2-dimensional Doppler echocardiography using fast Fourier transform spectral analysis. Am J Cardiol. 1982; 50(6):1394-400. DOI: 10.1016/0002-9149(82)90481-7. View

13.

Fisher D, Sahn D, Friedman M, Larson D, Horowitz S, Goldberg S . The mitral valve orifice method for noninvasive two-dimensional echo Doppler determinations of cardiac output. Circulation. 1983; 67(4):872-7. DOI: 10.1161/01.cir.67.4.872. View

14.

Cooper D, STEWART W, Schiavone W, Lombardo H, Lytle B, Loop F . Evaluation of normal prosthetic valve function by Doppler echocardiography. Am Heart J. 1987; 114(3):576-82. DOI: 10.1016/0002-8703(87)90755-1. View

15.

Holen J, Aaslid R, Landmark K, Simonsen S, Ostrem T . Determination of effective orifice area in mitral stenosis from non-invasive ultrasound Doppler data and mitral flow rate. Acta Med Scand. 1977; 201(1-2):83-8. DOI: 10.1111/j.0954-6820.1977.tb15660.x. View

16.

Labovitz A, Buckingham T, Habermehl K, Nelson J, KENNEDY H, Williams G . The effects of sampling site on the two-dimensional echo-Doppler determination of cardiac output. Am Heart J. 1985; 109(2):327-32. DOI: 10.1016/0002-8703(85)90602-7. View

17.

Lipkin D, Poole-Wilson P . Measurement of cardiac output during exercise by the thermodilution and direct Fick techniques in patients with chronic congestive heart failure. Am J Cardiol. 1985; 56(4):321-4. DOI: 10.1016/0002-9149(85)90857-4. View

18.

Hatle L, Angelsen B, Tromsdal A . Noninvasive assessment of atrioventricular pressure half-time by Doppler ultrasound. Circulation. 1979; 60(5):1096-104. DOI: 10.1161/01.cir.60.5.1096. View

19.

Wranne B, Ask P, Loyd D . Quantification of heart valve regurgitation: a critical analysis from a theoretical and experimental point of view. Clin Physiol. 1985; 5(1):81-8. DOI: 10.1111/j.1475-097x.1985.tb00749.x. View

20.

Sagar K, Wann L, Paulsen W, ROMHILT D . Doppler echocardiographic evaluation of Hancock and Björk-Shiley prosthetic values. J Am Coll Cardiol. 1986; 7(3):681-7. DOI: 10.1016/s0735-1097(86)80480-6. View