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Doppler echocardiographic estimation of mitral valve area during changing hemodynamic conditions

  • Alan C. Braverman
    Affiliations
    From the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts USA

    From the Cardiac Unit, Massachusetts General Hospital, Boston, Massachusetts USA
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  • James D. Thomas
    Footnotes
    Affiliations
    From the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts USA

    From the Cardiac Unit, Massachusetts General Hospital, Boston, Massachusetts USA
    Search for articles by this author
  • Richard T. Lee
    Correspondence
    Address for reprints: Richard T. Lee, MD, Cardiovascular Division, Brigham and Women's Hospital, 75 Francis Street, Boston, Massachusetts 02115.
    Footnotes
    Affiliations
    From the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts USA

    From the Cardiac Unit, Massachusetts General Hospital, Boston, Massachusetts USA
    Search for articles by this author
  • Author Footnotes
    2 Dr. Thomas is supported in part by the Bayer Fund for Cardiovascular Research, New York, New York.
    1 Dr. Lee is a recipient of Physician Scientist Award HL-01835 from the National Heart, Lung, and Blood Institute, Bethesda, Maryland.
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      Abstract

      Patients with mitral stenosis often present during periods of hemodynamic stress such as pregnancy or infections. The Doppler pressure half-time method of mitral valve area (MVA) determination is dependent on the net atrioventricular compliance as well as the peak transmitral gradient. The continuity equation method of MVA determination is based on conservation of mass and may be less sensitive to changes in the hemodynamic state. To test this hypothesis, 17 patients admitted for catheterization with symptomatic mitral stenosis and no more than mild regurgitation underwent Doppler echocardiography at rest and during supine bicycle exercise targeted to an increase in heart rate by 20 to 30 beats/minute. Net atrioventricular compliance was also estimated noninvasively. Cardiac output and transmitral gradient increased significantly during exercise (p < 0.001), while net atrioventricular compliance decreased (p < 0.001). MVA by the pressure half-time method increased significantly during exercise from 1.0 ± 0.2 to 1.4 ± 0.4 cm2 (p < 0.001). There was no significant difference in MVA estimation using the continuity equation comparing rest to exercise, with the mean area remaining constant at 0.8 ± 0.3 cm2 (p = 0.83). Thus, during conditions of changing hemodynamics, the continuity equation method for estimating MVA may be preferable to the pressure half-time method.
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