Author + information
- Received October 15, 1984
- Revision received March 27, 1985
- Accepted April 12, 1985
- Published online September 1, 1985.
- William J. Stewart, MD*,
- Leng Jiang, MD†,
- Robert Mich, MD,
- Natesa Pandian, MD,
- Jose Luis Guerrero and
- Arthur E. Weyman, MD, FACCa
- ↵aAddress for reprints: Arthur E. Weyman, MD, Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Fruit Street, Boston, Massachusetts 02114.
Doppler echocardiographic methods for measuring volumetric flow through the aortic, pulmonary and mitral salves provide the cardiologist with several potentially interchangeable noninvasive methods for determining cardiac output. In addition, comparison of flow differences through individual valves offers the potential to quantitate shunt flow and regurgitant volumes. To date, however, no study has compared the relative accuracies of each of these flow measurements in a controlled experimental setting. Therefore, in this study, Doppler echocardiography was used to measure aortic, pulmonary and mitral valve flows in seven open chest dogs on right atrial bypass where forward cardiac output was precisely controlled with a roller pump. Correlations with roller pump output were better for Doppler measurements of aortic (r = 0.98, SD = 0.3) and mitral (r = 0.97, SD = 0.3) than for pulmonary (r = 0.93, SD = 0.5) valve flow. Interobserver reproducibility was also better for aortic (r = 0.94) and mitral (r = 0.97) than for pulmonary (r = 0.88) valve flow measurements.
All valves showed flow-related increases in cross-sectional area, but the slope of this response was variable: 0.05, 0.16 and 0.21 for the aortic, the pulmonary and the mitral valve, respectively. Increased forward flow through the aortic valve, therefore, was manifested primarily by an increase in velocity, whereas increasing flow through the pulmonary and mitral valves produced more significant area changes with correspondingly smaller increases in the velocity component. Recalculation of Doppler-deiermined outputs, assuming a fixed valve area for the entire range of flows, resulted in a decreased correlation with roller pump output. Both velocity and valve area should be measured at each flow rate for greatest accuracy in volumetric flow calculations.
- Received October 15, 1984.
- Revision received March 27, 1985.
- Accepted April 12, 1985.
- American College of Cardiology Foundation