Noninvasive quantification of stenotic semilunar valve areas by doppler echocardiography

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Abstract

Fourteen patients, aged 1 month to 13 years, with congenital semilunar valve stenosis (11 pulmonary and 3 aortic) were studied for orifice area quantification calculated from a Doppler echocardiographic equation: Area = SV/0.88 × V2 × VET, where SV = stroke volume, V2 = maximal velocity and VET = ventricular ejection time. Results from individual measurements used in this formula and derived area were compared with individual results from cardiac catheterization and valve area derived from the Gorlin formula. Ventricular ejection time by cardiac catheterization ranged from 0.17 to 0.44 second (mean ± standard deviation [SD] 0.27 ± 0.09), and by Doppler study from 0.20 to 0.41 second (mean ± SD 0.29 ± 0.06) (r = 0.65, standard error of the estimate [SEE] = 0.03, y = 0.149 + 0.528x). Pressure gradient by catheterization ranged from 30 to 125 mm Hg (mean ± SD 56.6 ± 33.1), and by Doppler study from 17.6 to 100 mm Hg (mean ± SD 46.8 ± 27.9) (r = 0.91, SEE = 8.8, y = 1.23 + 0.904x). Stroke volume was measured by Doppler study simultaneously with cardiac catheterization in nine patients; results at cardiac catheterization with thermodilution measurements (cardiac output/heart rate) ranged from 5.5 to 53.4 cc (mean ± SD 24.7 ± 20), and by Doppler study from 5.8 to 46.9 cc (mean ± SD 23 ± 18) (r = 0.96, SEE = 3.5). Area quantification was performed in two ways. In Group 1, heart rate-matched stroke volumes from cardiac catheterization were used in the derived equation for Doppler study (all patients). In Group 2, the stroke volume used was that obtained by Doppler study, which was performed simultaneously with cardiac catheterization (nine patients). Results for Gorlin formula area quantification in Group 1 ranged from 0.05 to 1.42 cm2 (mean ± SD 0.41 ± 0.36), and for the Doppler-derived equation in this group from 0.05 to 0.91 cm2 (mean ± SD 0.32 ± 0.25) (r = 0.90, SEE = 0.08, y = 0.053 ± 0.665x). When results were compared in the simultaneously studied patients, catheterization (Gorlin formula)-calculated areas ranged from 0.05 to 1.424 cm2 (mean ± SD 0.52 ± 0.42), and for the Doppler-derived equation, areas ranged from 0.06 to 0.97 cm2 (mean ± SD 0.35 ± 0.29) (r = 0.94, SEE = 0.07, y = 0.037 ± 0.656x). This study shows that accurate quantification of stenotic semilunar valve orifice areas can be made by Doppler echocardiography. © 1984, American College of Cardiology Foundation. All rights reserved.

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Kosturakis, D., Allen, H. D., Goldberg, S. J., Sahn, D. J., & Valdes-Cruz, L. M. (1984). Noninvasive quantification of stenotic semilunar valve areas by doppler echocardiography. Journal of the American College of Cardiology, 3(5), 1256–1262. https://doi.org/10.1016/S0735-1097(84)80185-0

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