Assessment of small-diameter aortic mechanical prostheses : Physiological relevance of the Doppler gradient, utility of flow augmentation, and limitations of orifice area estimation
Noninvasive assessment of functionally stenotic small-diameter aortic mechanical prostheses is complicated by theoretical constraints relating to the hemodynamic relevance of Doppler-derived transprosthetic gradients. To establish the utility of Doppler echocardiography for evaluation of these valve...
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| Veröffentlicht in: | Circulation (New York, N.Y.) N.Y.), 1998-09, Vol.98 (9), p.866-872 |
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| creator | MARCUS, R. H HEINRICH, R. S LANG, R. M BEDNARZ, J LUPOVITCH, S ABRUZZO, J BOROK, R VANDENBERG, B KERBER, R. E PICCIONE, W YOGANATHAN, A. P |
| description | Noninvasive assessment of functionally stenotic small-diameter aortic mechanical prostheses is complicated by theoretical constraints relating to the hemodynamic relevance of Doppler-derived transprosthetic gradients. To establish the utility of Doppler echocardiography for evaluation of these valves, 20-mm Medtronic Hall and 19-mm St Jude prostheses were studied in vitro and in vivo.
Relations between the orifice transprosthetic gradient (equivalent to Doppler), the downstream gradient in the zone of recovered pressure (equivalent to catheter), and fluid mechanical energy losses were examined in vitro. Pressure-flow relations across the 2 prostheses were evaluated by Doppler echocardiography in vivo. For both types of prosthesis in vitro, the orifice was higher than the downstream gradient (P |
| doi_str_mv | 10.1161/01.CIR.98.9.866 |
| format | Article |
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Relations between the orifice transprosthetic gradient (equivalent to Doppler), the downstream gradient in the zone of recovered pressure (equivalent to catheter), and fluid mechanical energy losses were examined in vitro. Pressure-flow relations across the 2 prostheses were evaluated by Doppler echocardiography in vivo. For both types of prosthesis in vitro, the orifice was higher than the downstream gradient (P<0.001), and fluid mechanical energy losses were as strongly correlated with orifice as with downstream pressure gradients (r2=0.99 for both). Orifice and downstream gradients were higher and fluid mechanical energy losses were larger for the St Jude than the Medtronic Hall valve (all P<0.001). Whereas estimated effective orifice areas for the 2 valves in vivo were not significantly different, model-independent dynamic analysis of pressure-flow relations revealed higher gradients for the St Jude than the Medtronic Hall valve at a given flow rate (P<0.05).
Even in the presence of significant pressure recovery, the Doppler-derived gradient across small-diameter aortic mechanical prostheses does have hemodynamic relevance insofar as it reflects myocardial energy expenditure. Small differences in function between stenotic aortic mechanical prostheses, undetectable by conventional orifice area estimations, can be identified by dynamic Doppler echocardiographic analysis of pressure-flow relations.</description><identifier>ISSN: 0009-7322</identifier><identifier>EISSN: 1524-4539</identifier><identifier>DOI: 10.1161/01.CIR.98.9.866</identifier><identifier>PMID: 9738641</identifier><identifier>CODEN: CIRCAZ</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott Williams & Wilkins</publisher><subject>Aortic Valve Stenosis - diagnostic imaging ; Aortic Valve Stenosis - physiopathology ; Aortic Valve Stenosis - surgery ; Biological and medical sciences ; Blood Flow Velocity ; Blood Vessel Prosthesis - standards ; Cardiac Output - drug effects ; Cardiac Output - physiology ; Cardiotonic Agents - administration & dosage ; Dobutamine - administration & dosage ; Echocardiography ; Humans ; Medical sciences ; Models, Cardiovascular ; Pressure ; Stress, Mechanical ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Surgery of the heart ; Treatment Failure</subject><ispartof>Circulation (New York, N.Y.), 1998-09, Vol.98 (9), p.866-872</ispartof><rights>1998 INIST-CNRS</rights><rights>Copyright American Heart Association, Inc. Sep 1, 1998</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c342t-5554dde9502165df2e819dbabf38808a5f9ef4aaf3a3076bcce25166f20b6e553</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,3687,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=2366228$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/9738641$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>MARCUS, R. H</creatorcontrib><creatorcontrib>HEINRICH, R. S</creatorcontrib><creatorcontrib>LANG, R. M</creatorcontrib><creatorcontrib>BEDNARZ, J</creatorcontrib><creatorcontrib>LUPOVITCH, S</creatorcontrib><creatorcontrib>ABRUZZO, J</creatorcontrib><creatorcontrib>BOROK, R</creatorcontrib><creatorcontrib>VANDENBERG, B</creatorcontrib><creatorcontrib>KERBER, R. E</creatorcontrib><creatorcontrib>PICCIONE, W</creatorcontrib><creatorcontrib>YOGANATHAN, A. P</creatorcontrib><title>Assessment of small-diameter aortic mechanical prostheses : Physiological relevance of the Doppler gradient, utility of flow augmentation, and limitations of orifice area estimation</title><title>Circulation (New York, N.Y.)</title><addtitle>Circulation</addtitle><description>Noninvasive assessment of functionally stenotic small-diameter aortic mechanical prostheses is complicated by theoretical constraints relating to the hemodynamic relevance of Doppler-derived transprosthetic gradients. To establish the utility of Doppler echocardiography for evaluation of these valves, 20-mm Medtronic Hall and 19-mm St Jude prostheses were studied in vitro and in vivo.
Relations between the orifice transprosthetic gradient (equivalent to Doppler), the downstream gradient in the zone of recovered pressure (equivalent to catheter), and fluid mechanical energy losses were examined in vitro. Pressure-flow relations across the 2 prostheses were evaluated by Doppler echocardiography in vivo. For both types of prosthesis in vitro, the orifice was higher than the downstream gradient (P<0.001), and fluid mechanical energy losses were as strongly correlated with orifice as with downstream pressure gradients (r2=0.99 for both). Orifice and downstream gradients were higher and fluid mechanical energy losses were larger for the St Jude than the Medtronic Hall valve (all P<0.001). Whereas estimated effective orifice areas for the 2 valves in vivo were not significantly different, model-independent dynamic analysis of pressure-flow relations revealed higher gradients for the St Jude than the Medtronic Hall valve at a given flow rate (P<0.05).
Even in the presence of significant pressure recovery, the Doppler-derived gradient across small-diameter aortic mechanical prostheses does have hemodynamic relevance insofar as it reflects myocardial energy expenditure. Small differences in function between stenotic aortic mechanical prostheses, undetectable by conventional orifice area estimations, can be identified by dynamic Doppler echocardiographic analysis of pressure-flow relations.</description><subject>Aortic Valve Stenosis - diagnostic imaging</subject><subject>Aortic Valve Stenosis - physiopathology</subject><subject>Aortic Valve Stenosis - surgery</subject><subject>Biological and medical sciences</subject><subject>Blood Flow Velocity</subject><subject>Blood Vessel Prosthesis - standards</subject><subject>Cardiac Output - drug effects</subject><subject>Cardiac Output - physiology</subject><subject>Cardiotonic Agents - administration & dosage</subject><subject>Dobutamine - administration & dosage</subject><subject>Echocardiography</subject><subject>Humans</subject><subject>Medical sciences</subject><subject>Models, Cardiovascular</subject><subject>Pressure</subject><subject>Stress, Mechanical</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Surgery of the heart</subject><subject>Treatment Failure</subject><issn>0009-7322</issn><issn>1524-4539</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1998</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkU1v1DAQhi0EKtvCmROShVBPTeqP2LF7q5avSpVACM6WNxnvunLixU5A-8P4fzjdVQ-crNH7zDueeRF6Q0lNqaTXhNbru--1VrWulZTP0IoK1lSN4Po5WhFCdNVyxl6i85wfSil5K87QmW65kg1dob-3OUPOA4wTjg7nwYZQ9d4OMEHCNqbJd3iAbmdH39mA9ynmaQelB9_gb7tD9jHE7aOUIMBvO3awGBUGf4j7fSgu22R7XwZc4XnywU-HBXAh_sF23i6T7eTjeIXt2OPgB3-s80LF5J0vjjaBxZAnPzxqr9ALZ0OG16f3Av389PHH-kt1__Xz3fr2vup4w6ZKCNH0PWhBGJWidwwU1f3GbhxXiigrnAbXWOu45aSVm64DJqiUjpGNBCH4Bbo8-pa1f81lvhl87iAEO0Kcs2m5Jm1DVAHf_Qc-xDmN5W-GUdaycm9eoOsj1JUj5gTO7FNZKB0MJWZJ0xBqSppGK6NNSbN0vD3ZzpsB-if-FF_R3590m0sELpXz-_yEMS4lY4r_A0mGq9M</recordid><startdate>19980901</startdate><enddate>19980901</enddate><creator>MARCUS, R. H</creator><creator>HEINRICH, R. S</creator><creator>LANG, R. M</creator><creator>BEDNARZ, J</creator><creator>LUPOVITCH, S</creator><creator>ABRUZZO, J</creator><creator>BOROK, R</creator><creator>VANDENBERG, B</creator><creator>KERBER, R. E</creator><creator>PICCIONE, W</creator><creator>YOGANATHAN, A. P</creator><general>Lippincott Williams & Wilkins</general><general>American Heart Association, Inc</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>U9A</scope><scope>7X8</scope></search><sort><creationdate>19980901</creationdate><title>Assessment of small-diameter aortic mechanical prostheses : Physiological relevance of the Doppler gradient, utility of flow augmentation, and limitations of orifice area estimation</title><author>MARCUS, R. H ; HEINRICH, R. S ; LANG, R. M ; BEDNARZ, J ; LUPOVITCH, S ; ABRUZZO, J ; BOROK, R ; VANDENBERG, B ; KERBER, R. E ; PICCIONE, W ; YOGANATHAN, A. 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P</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Assessment of small-diameter aortic mechanical prostheses : Physiological relevance of the Doppler gradient, utility of flow augmentation, and limitations of orifice area estimation</atitle><jtitle>Circulation (New York, N.Y.)</jtitle><addtitle>Circulation</addtitle><date>1998-09-01</date><risdate>1998</risdate><volume>98</volume><issue>9</issue><spage>866</spage><epage>872</epage><pages>866-872</pages><issn>0009-7322</issn><eissn>1524-4539</eissn><coden>CIRCAZ</coden><abstract>Noninvasive assessment of functionally stenotic small-diameter aortic mechanical prostheses is complicated by theoretical constraints relating to the hemodynamic relevance of Doppler-derived transprosthetic gradients. To establish the utility of Doppler echocardiography for evaluation of these valves, 20-mm Medtronic Hall and 19-mm St Jude prostheses were studied in vitro and in vivo.
Relations between the orifice transprosthetic gradient (equivalent to Doppler), the downstream gradient in the zone of recovered pressure (equivalent to catheter), and fluid mechanical energy losses were examined in vitro. Pressure-flow relations across the 2 prostheses were evaluated by Doppler echocardiography in vivo. For both types of prosthesis in vitro, the orifice was higher than the downstream gradient (P<0.001), and fluid mechanical energy losses were as strongly correlated with orifice as with downstream pressure gradients (r2=0.99 for both). Orifice and downstream gradients were higher and fluid mechanical energy losses were larger for the St Jude than the Medtronic Hall valve (all P<0.001). Whereas estimated effective orifice areas for the 2 valves in vivo were not significantly different, model-independent dynamic analysis of pressure-flow relations revealed higher gradients for the St Jude than the Medtronic Hall valve at a given flow rate (P<0.05).
Even in the presence of significant pressure recovery, the Doppler-derived gradient across small-diameter aortic mechanical prostheses does have hemodynamic relevance insofar as it reflects myocardial energy expenditure. Small differences in function between stenotic aortic mechanical prostheses, undetectable by conventional orifice area estimations, can be identified by dynamic Doppler echocardiographic analysis of pressure-flow relations.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams & Wilkins</pub><pmid>9738641</pmid><doi>10.1161/01.CIR.98.9.866</doi><tpages>7</tpages></addata></record> |
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| ispartof | Circulation (New York, N.Y.), 1998-09, Vol.98 (9), p.866-872 |
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| source | MEDLINE; American Heart Association Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Journals@Ovid Ovid Autoload |
| subjects | Aortic Valve Stenosis - diagnostic imaging Aortic Valve Stenosis - physiopathology Aortic Valve Stenosis - surgery Biological and medical sciences Blood Flow Velocity Blood Vessel Prosthesis - standards Cardiac Output - drug effects Cardiac Output - physiology Cardiotonic Agents - administration & dosage Dobutamine - administration & dosage Echocardiography Humans Medical sciences Models, Cardiovascular Pressure Stress, Mechanical Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the heart Treatment Failure |
| title | Assessment of small-diameter aortic mechanical prostheses : Physiological relevance of the Doppler gradient, utility of flow augmentation, and limitations of orifice area estimation |
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