Principles of Quantification of Valvular Regurgitation

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  • 弁逆流定量評価の基本

Description

Grading of valvular regurgitation is mandatory for management of patients with valvular heart disease. Simple measurement, satisfactory reliability and reproducibility are required as ideal parameters for clinical use. Each parameter has its coherent value and limitations. All variables do not show concordance in terms of severity. There is no gold standard for quantitating valvular regurgitation. The main purpose of grading is to differentiate mild from moderate severity, or to determine the severity when the clinical profile is not consistent with the severity of cardiovascular findings. Beginners should be familiar with some of the parameters. Distribution of regurgitant signals graded by three or four scales are simple, semi-quantitative, and useful parameters in aortic (AR) and mitral regurgitation (MR). Regurgitant area relative to the size of the atrium is also utilized. Vena contracta, the narrowest portion of the regurgitant jet downstream from the orifice, is a simple parameter in AR and MR. Regurgitant width and area of AR or its ratio to the outflow tract width or area are also variables. Pressure half time and decay slope of regurgitant signal are also utilized in AR. Regurgitant volume, fraction and orifice area can be calculated by proximal isovelocity surface area (PISA), which is independent of the configuration of the regurgitant jet. However, the method is not used for mild regurgitation because of absence of flow convergence. Regurgitant volume and regurgitant fraction calculated by utilizing the continuity equation are other useful Doppler variables, which are not affected by area or distribution of regurgitant signals. It should be emphasized that the above-mentioned parameters are not part of the guidelines of the U.S.A and Japan for timing of valve surgery. Left ventricular dimension, ejection fraction and pulmonary artery pressure have been proposed as much more important variables.

Journal

  • Choonpa Igaku

    Choonpa Igaku 33 (6), 621-630, 2006

    The Japan Society of Ultrasonics in Medicine

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