Author + information
- Received August 26, 1991
- Revision received December 4, 1991
- Accepted January 3, 1992
- Published online June 1, 1992.
- Hans J. Deutsch, MDa,
- Rainald Bachmannb,
- Udo Sechtem, MDa,∗,
- Julius M. Curtius, MDa,
- Markus Jungehülsing, MDb,
- Harald Schicha, MDb and
- Hans H. Hilger, MDa
- ↵∗Address for reprints: Udo Sechtem, MD, Klinik III für Innere Medizin, Universität zu Köln, Joseph-Stelzmann-Str. 9, 5000 Cologne 41, Germany.
Gradient echo nuclear magnetic resonance (NMR) imaging and transesophageal two-dimensional color Doppler echocardiography are flow-sensitive techniques that have been used in the diagnosis and grading of valvular regurgitation. To define the diagnostic value of gradient echo NMR imaging in the detection of regurgitant flow in cardiac valve prostheses and the differentiation of physiologic leakage flow from pathologic transvalvular or paravalvular leakage flow, 47 patients with 55 valve prostheses were examined. Color Doppler transesophageal echocardiography was used for comparison. Surgical confirmation of findings was obtained in 11 patients with 13 valve prostheses.
Gradient echo NMR imaging showed reguraitant flow in 37 of 43 valves with a jet seen on transesophageal echocardiography and it detected physiologic leakage flow in 4 additional valves. There was 96% agreement between the two methods in distinguishing between physiologic and pathologic leakage flow. The methods differed on jet origin of pathologic leakage flow in six prostheses. The degree of regurgitation was graded by both NMR imaging and transesophageal echocardiography, according to the area of the regurgitant jet visualized; gradings were identical for 75% of valve prostheses. Quantification of jet length and area showed a good correlation between the two methods (r = 0.85 and r = 0.91, respectively).
Gradient echo NMR imaging is a useful noninvgsive technique for the detection, localization and estimation of regurgitant flow in cardiac valve prostheses. However, because transesophageal echocardiography is less time-consuming and less expensive, gradient echo NMR imaging is unlikely to displace transesophageal echocardiography and should be used only in the occasional patient who cannot be adequately imaged by echocardiography.
- Received August 26, 1991.
- Revision received December 4, 1991.
- Accepted January 3, 1992.