Sequential assessment of mitral valve area during diastole using colour M-mode flow convergence analysis: New insights into mitral stenosis physiology

David Messika-Zeitoun, Siu Fung Yiu, Bertrand Cormier, Bernard Iung, Christopher Scott, Alec Vahanian, A. Jamil Tajik, Maurice Enriquez-Sarano

Research output: Contribution to journalArticle

23 Scopus citations

Abstract

Aims: In mitral stenosis (MS) transvalvular flow and velocity continually change through-out diastole but for mitral valve area (MVA), flow-dependent variations (valve reserve) are unknown. These physiologic changes can be studied by the proximal isovelocity surface area (PISA) method, using the high temporal resolution of colour M-mode, essential for simultaneous measurements of flow and velocity. Hence, we aimed to validate the colour M-mode PISA method for measurement of MVA in MS and to define using this method the physiologic flow-dependent changes of MVA during diastole. Methods and results: In 50 patients with native MS, MVA was measured by planimetry (MVA-2D), Doppler pressure half-time (MVA-PHT), and two-dimensional PISA (2D-PISA). MVA measurement by colour M-mode PISA in early diastole (M-PISA) (1.27± 0.46 cm2) with rigorously timed flow and velocity measurements by continuous wave Doppler did not differ and correlated well with MVA-2D (1.29±0.44 cm2, p=0.59; r=0.85, p<0.001) and MVA-PHT (1.30±0.41 cm2, p=0.52; r=0.80, p<0.001). In contrast a trend towards underestimation of MVA by 2D-PISA was observed (1.23±0.42 cm2; p=0.10 and p=0.07). Timed analysis of transvalvular haemodynamics at early, mid, mid-late, and late diastole showed marked changes in flow and velocities (both p<0.0001) but not in MVA (respectively 1.27±0.46, 1.29±0.47, 1.28<0.51 and 1.27±0.49 cm2; ns). Conclusions: In MS, the high temporal resolution of colour M-mode PISA allows accurate MVA measurements. It also allows for the first time, sequential MVA assessment during diastole. Notwithstanding marked flow and velocities changes, MVA remained unchanged throughout diastole underscoring the lack of flow-related valvular reserve in MS.

Original languageEnglish (US)
Pages (from-to)1244-1253
Number of pages10
JournalEuropean heart journal
Volume24
Issue number13
DOIs
StatePublished - Jul 1 2003

Keywords

  • Blood flow
  • Echocardiography
  • Haemodynamics
  • Mitral valve
  • PISA

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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