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DOPPLER ECHOCARDIOGRAPHIC ASSESSMENT OF VALVAR REGURGITATION
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  1. James D Thomas
  1. Correspondence to:
    James D Thomas MD, Department of Cardiology, Desk F15, 9500 Euclid Avenue, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA;
    thomasj{at}ccf.org

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Improvements in outcomes for heart valve surgery, in particular mitral valve repair, have dictated a need for better assessment of valvar regurgitation. Whereas in the past surgery was delayed until the patient’s symptomatic status required intervention, patients today are often sent to the operating room while still asymptomatic or minimally symptomatic. Before committing an asymptomatic patient to open heart surgery, however, it is essential that the severity of valvar regurgitation be quantified to ensure the surgery is actually required. Doppler echocardiography has emerged as the premier way of assessing valvar regurgitation, as it allows characterisation of valve morphology, severity of regurgitation, and secondary effects, such as left ventricular dysfunction, left atrial enlargement, and pulmonary hypertension. This review will outline current methods available to the echocardiographer in assessing valvar regurgitation, focusing on simple practical ways that true quantitative information can be obtained in a clinical laboratory. Techniques that are generally applicable in all forms of valve regurgitation will be introduced first, followed by specific techniques for mitral and aortic regurgitation.

COLOUR JET AREA METHOD

The most common way of assessing the severity of valvar regurgitation is to inspect the area of the colour Doppler jet in the downstream chamber.1 The advantage of this approach is that it is fast, easy, and also provides information on the mechanism of regurgitation, as the jet is generally directed away from the most severely affected leaflet. However, jet area alone is impacted by many factors other than regurgitant flow rate, and an understanding of these will aid in its utilisation.

Determinants of colour jet Doppler area

The physical parameter that is most predictive of the size of a regurgitant jet by colour Doppler is jet momentum, given by the product of regurgitant flow rate multiplied by velocity.2 Since jet velocity is directly related to the driving pressure across a regurgitant orifice (by the …

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