Skip to main content
NCBI home page
Clinical Cardiology logoLink to Clinical Cardiology
. 2007 Jul 5;25(11):517–524. doi: 10.1002/clc.4960251108

Quantification of Mitral Regurgitation by the Proximal Flow Convergence Method—Comparison of Transthoracic and Transesophageal Echocardiography

Georg Grossmann 1,✉, Jochen Wöhrle 1, Matthias Kochs 1, Martin Giesler 1, Vinzenz Hombach 1, Martin Höher 1
PMCID: PMC6653930  PMID: 12430782

Abstract

Background: No data exist to indicate whether transthoracic (TTE) and transesophageal echocardiography (TEE) are of comparable value for the detection and quantification of mitral regurgitation using the proximal flow convergence method.

Hypothesis: The study was performed to compare the value of TTE and TEE for the detection and quantification of mitral regurgitation using this method.

Methods: The study included 57 patients with and 11 patients without mitral regurgitation. In all patients, the proximal flow convergence region was imaged by transthoracic and transesophageal color Doppler echocardiography, and proximal isovelocity surface area radii were determined. In 19 patients, monoplane TEE and in 49 patients multiplane TEE was performed. Thirty‐one patients with mitral regurgitation underwent cardiac catheterization.

Results: Both methods had a comparable sensitivity for the detection of mitral regurgitation. Proximal isovelocity surface area radii derived from TTE and TEE agreed moderately (mean difference −0.5 ±1.3 mm). TTE and TEE correlated significantly with the angiographic grade (rank correlation coefficients 0.83 and 0.81), and both differentiated mild to moderate from severe mitral regurgitation with an accuracy of 90%. Regurgitant volumes derived from both echocardiographic techniques and cardiac catheterization correlated moderately (correlation coefficients between 0.67 and 0.81).

Conclusions: TTE and TEE were of comparable value for the detection and quantification of mitral regurgitation using the proximal flow convergence method.

Keywords: mitral regurgitation, transthoracic echocardiography, transesophageal echocardiography, color Doppler imaging, proximal flow convergence region

Full Text

The Full Text of this article is available as a PDF (100.6 KB).

References

  • 1. Slater J, Gindea AJ, Freedberg RS, Chinitz LA, Tunick PA, Rosenzweig BP, Winer HE, Goldfarb A, Perez JL, Glassman E, Kronzon I: Comparison of cardiac catheterization and Doppler echocardiography in the decision to operate in aortic and mitral valve disease. J Am Coll Cardiol 1991; 17: 1026–1036. [DOI] [PubMed] [Google Scholar]
  • 2. Feigenbaum H: Acquired valvular heart disease In Echocardiography, 5th Ed. (Ed. Feigenbaum H), p. 239–349. Philadelphia: Lea & Febiger, 1994. [Google Scholar]
  • 3. Recusani F, Bargiggia GS, Yoganathan AP, Raisaro A, Valdes‐Cruz LM, Sung H‐W, Bertucci C, Gallati M, Moises VA, Simpson IA, Tronconi L, Sahn DJ: A new method for quantification of regurgitant flow rate using color Doppler flow imaging of the flow convergence region proximal to a discrete orifice. An in vitro study. Circulation 1991; 83: 594–604. [DOI] [PubMed] [Google Scholar]
  • 4. Bargiggia GS, Tronconi L, Sahn DJ, Recusani F, Raisaro A, De Servi S, Valdes‐Cruz LM, Montemartini C: A new method for the quantitation of mitral regurgitation based on color flow Doppler imaging of flow convergence proximal to regurgitant orifice. Circulation 1991; 84: 1481–1489. [DOI] [PubMed] [Google Scholar]
  • 5. Rivera JM, Vandervoort PM, Thoreau DH, Levine RA, Weyman AE, Thomas JD: Quantification of mitral regurgitation with the proximal flow convergence method: A clinical study. Am Heart J 1992; 124: 1289–1296. [DOI] [PubMed] [Google Scholar]
  • 6. Giesler M, Grossmann G, Schmidt A, Kochs M, Langhans J, Stauch M, Hombach V: Color Doppler echocardiographic determination of mitral regurgitant flow from the proximal velocity profile of the flow convergence region. Am J Cardiol 1993; 71: 217–224. [DOI] [PubMed] [Google Scholar]
  • 7. Yoshida K, Yoshikawa J, Akasaka T, Nishigami K, Minagoe S: Value of acceleration flow signals proximal to the leaking orifice in assessing the severity of prosthetic mitral valve regurgitation. J Am Coll Cardiol 1992; 19: 333–338. [DOI] [PubMed] [Google Scholar]
  • 8. Pu M, Vandervoort PM, Griffin BP, Leung DY, Stewart WJ, Cosgrove DM III, Thomas JD: Quantification of mitral regurgitation by the proximal convergence method using transesophageal echocardiography. Circulation 1995; 92: 2169–2177. [DOI] [PubMed] [Google Scholar]
  • 9. Flachskampf FA, Frieske R, Engelhard B, Grenner H, Frielingsdorf J, Beck F, Reineke T, Thomas JD, Hanrath P: Comparison of transesophageal Doppler methods with angiography for evaluation of the severity of mitral regurgitation. J Am Soc Echocardiogr 1998; 11: 882–892. [DOI] [PubMed] [Google Scholar]
  • 10. Kolev N, Brase R, Wolner E, Zimpfer M: Quantification of mitral regurgitant flow using proximal isovelocity surface area method: A transesophageal echocardiography perioperative study. J Cardiothorac Vasc Anesth 1998; 12: 22–26. [DOI] [PubMed] [Google Scholar]
  • 11. Enriquez‐Sarano M, Tajik J, Bailey KR, Seward JB: Color flow imaging compared with quantitative Doppler assessment of severity of mitral regurgitation: Influence of eccentricity of jet and mechanism of regurgitation. J Am Coll Cardiol 1993; 21: 1211–1219. [DOI] [PubMed] [Google Scholar]
  • 12. Sellers RD, Levy MJ, Amplatz K, Lillehei CW: Left retrograde cardioangiography in acquired cardiac disease. Technic, indications and interpretations in 700 cases. Am J Cardiol 1964; 14: 437–447. [DOI] [PubMed] [Google Scholar]
  • 13. Bland JM, Altman DG: Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986; 1: 307–310. [PubMed] [Google Scholar]
  • 14. Smith MD, Harrison MR, Pinton R, Kandil H, Ling Kwan O, DeMaria AN: Regurgitant jet size by transesophageal compared with transthoracic Doppler color flow imaging. Circulation 1991; 83: 79–86. [DOI] [PubMed] [Google Scholar]
  • 15. Carabello BA: What exactly is 2+ to 3+ mitral regurgitation? J Am Coll Cardiol 1992; 19: 339–340. [DOI] [PubMed] [Google Scholar]
  • 16. Grossmann G, Giesler M, Schmidt A, Kochs M, Wieshammer S, Höher M, Felder C, Hombach V: Influence of the mechanism of regurgitation on the quantification of mitral regurgitation by the proximal flow convergence method and the jet area method. Eur Heart J 1996; 17: 1256–1264. [DOI] [PubMed] [Google Scholar]
  • 17. Enriquez‐Sarano M, Miller FA Jr, Hayes SN, Bailey KR, Tajik AJ, Seward JB: Effective mitral regurgitant orifice area: Clinical use and pitfalls of the proximal isovelocity surface area method. J Am Coll Cardiol 1995; 25: 703–709. [DOI] [PubMed] [Google Scholar]
  • 18. Croft CH, Lipscomb K, Mathis K, Firth BG, Nicod P, Tilton G: Limitations of qualitative angiographic grading in aortic or mitral regurgitation. Am J Cardiol 1984; 53: 1593–1598. [DOI] [PubMed] [Google Scholar]
  • 19. Krayenbuehl HP, Ritter M, Hess OM, Hirzel H: The use of invasive techniques, angiography and indicator dilution, for quantification of valvular regurgitations. Eur Heart J 1987; 8(suppl. C): 1–9 [DOI] [PubMed] [Google Scholar]
  • 20. Cape EG, Thomas JD, Weyman AE, Yoganathan AP, Levine RA: Three‐dimensional surface geometry correction is required for calculating flow by the proximal isovelocity surface area technique. J Am Soc Echocardiogr 1995; 8: 585–594. [DOI] [PubMed] [Google Scholar]
  • 21. Salustri A, Becker AE, vanHerwerden L, Vletter WB, Ten Cate FJ, Roelandt JRTC: Three‐dimensional echocardiography of normal and pathologic mitral valve: A comparison with two‐dimensional transesophageal echocardiography. J Am Coll Cardiol 1996; 27: 1502–1510. [DOI] [PubMed] [Google Scholar]
  • 22. Vandervoort PM, Thoreau DH, Rivera JM, Levine RA, Weyman AE, Thomas JD: Automated flow rate calculations based on digital analysis of flow convergence proximal to regurgitant orifices. J Am Coll Cardiol 1993; 22: 535–541. [DOI] [PubMed] [Google Scholar]
  • 23. Schwammenthal E, Chen C, Benning F, Block M, Breithardt G, Levine RA: Dynamics of mitral regurgitant flow and orifice area. Physiologic application of the proximal flow convergence method: Clinical data and experimental testing. Circulation 1994; 90: 307–322. [DOI] [PubMed] [Google Scholar]
  • 24. Giesler M, Grossmann G, Pfob A, Bajtay D, Göller V, Hombach V: Color Doppler echocardiography of the flow convergence region in vitro: Influence of orifice shape on the proximal velocity profile. Z Kardiol 1996; 85: 45–52. [PubMed] [Google Scholar]
  • 25. Utsunomiya T, Ogawa T, Doshi R, Patel D, Quan M, Henry WL: Doppler color flow “proximal isovelocity surface area” method for estimating volume flow rate: Effects of orifice shape and machine factors. J Am Coll Cardiol 1991; 17: 1103–1111. [DOI] [PubMed] [Google Scholar]
  • 26. Shandas R, Gharib M, Liepmann D, Shiota T, Sahn DJ: Experimental studies to define the geometry of the flow convergence region. Laser Doppler particle tracking and color Doppler imaging. Echocardiography 1992; 9: 43–50. [DOI] [PubMed] [Google Scholar]
  • 27. Schwammenthal E, Chen C, Giesler M, Sagie A, Guerrero JL, Vazquez De Prada JA, Hombach V, Weyman AE, Levine RA: New method for accurate calculation of regurgitant flow rate based on analysis of Doppler color flow maps of the proximal flow field. Validation in a canine model of mitral regurgitation with initial application in patients. J Am Coll Cardiol 1996; 27: 161–172. [DOI] [PubMed] [Google Scholar]
  • 28. Bolger AF, Eigler NL, Maurer G: Quantifying valvular regurgitation. Limitations and inherent assumptions of Doppler techniques. Circulation 1988; 78: 1316–1318. [DOI] [PubMed] [Google Scholar]
  • 29. Hoit BD, Jones M, Eidbo EE, Elias W, Sahn DJ: Sources of variability for Doppler color flow mapping of regurgitant jets in an animal model of mitral regurgitation. J Am Coll Cardiol 1989; 13: 1631–1636. [DOI] [PubMed] [Google Scholar]
  • 30. Enriquez‐Sarano M, Freeman WK, Tribouilly CM, Orszulak TA, Khandria BK, Seward JB, Bailey KR, Tajik AJ: Functional anatomy of mitral regurgitation: Accuracy and outcome implications of transesophageal echocardiography. J Am Coll Cardiol 1999; 34: 1129–1136. [DOI] [PubMed] [Google Scholar]

Articles from Clinical Cardiology are provided here courtesy of Wiley

RESOURCES