Quantification of regurgitant flow through bileaflet heart valve prostheses: theoretical and in vitro studies

Quantitative assessment of in vitro jets based on three-dimensional color Doppler reconstruction

Three-dimensional (3-D) color Doppler imaging of flow jets was performed to investigate the effects of flow rate and orifice size on jet volumes. Flow jets were generated using a flow model to simulate mitral regurgitation. This flow model consisted of a ventricular chamber, a valvular plate and an atrial chamber. Steady flow was driven through circular orifices having diameters of 2.5, 3.5, 4.5, and 6 mm, respectively, with flow rates of 5, 10, 15, 20, and 25 mL/s to form free jets in the atrial chamber. An ATL Ultramark 9 HDI system was used to perform 3-D color Doppler imaging of the flow jets. A transesophageal probe was rotated by a stepper motor to create 3-D color Doppler images of the jets. The color jet volumes for different hemodynamic conditions were measured and then compared with the theoretical predictions. Results showed that the jet volume estimated from the 3-D color Doppler was directly proportional to the flow rate and inversely proportional to the orifice size. The estimated jet volumes correlated well (r > 0.95) with theoretical predictions. This study supports the use of color jet volume as a parameter to quantify mitral regurgitation.

Heart motion-adapted MR velocity mapping of blood velocity distribution downstream of aortic valve prostheses: initial experience

PURPOSE

To investigate blood flow velocities and shear rates at two distances downstream of an artificial aortic valve in patients.

MATERIALS AND METHODS

Blood velocity was quantified downstream of the valve prosthesis (for replacement after aortic valve stenosis or combined stenosis and regurgitation) in 10 patients by using a magnetic resonance (MR) cine velocity mapping method in which the imaging section position is adapted according to the excursion of the valvular plane of the heart. Two acquisitions were performed to display the blood velocity distributions one-fourth valve diameter and one valve diameter downstream of the valve and to quantify blood volumes and shear rates.

RESULTS

The velocity profiles measured during flow acceleration one-fourth valve diameter downstream were characterized by a distinct pattern of two lateral jets and one central jet of antegrade flow. High shear rates were found along the leaflet tips. The profiles obtained one valve diameter downstream were skewed, with varying velocity patterns among patients. Peak shear rates were found close to the vessel wall. With correction for through-plane motion of the valve, the mean apparent regurgitant fraction (+/- SD) was 14% +/- 6; the mean regurgitant fraction without correction was 9% +/- 5.

CONCLUSION

The described noninvasive procedure for velocity mapping enables measurements close to the valve and thus evaluation of blood flow patterns with respect to valve design in humans.