Automated flow rate calculation based on digital analysis of flow convergence proximal to regurgitant orifice

AbstractObjectives. The purpose of the study was to develop and validate an automated method for calculating regurgitant flow rate using color Doppler echocardiography.Background. The proximal flow convergence method is a promising approach to quantitate valvular regurgitation noninvasively because it allows one to calculate regurgitant flow rate and regurgitant orifice area; however, defining the location of the regurgitant orifice is often difficult and can lead to significant error in the calculated flow rates. To overcome this problem we developed an automated algorithm to locate the orifice and calculate flow rate based on the digital Doppler velocity map.Methods. This algorithm compares the observed velocities with the anticipated relative velocities, cos ϑ/μt2. The orifice is localized as the point with maximal correlation between predicted and observed velocity, whereas flow rate is specified as the slope of the regression line. We validated this algorithm in an in vitro model for flow through circular orifices with planar surroundings and a porcine bioprosthesis.Results. For flow through circular orifices, flow rates calculated on individual Doppler maps and on an average of eight velocity maps showed excellent agreement with true flow, with r = 0.977 and ΔQ = −3.7 ± 15.8 cm3/s and r = 0.991 and ΔQ = −4.3 ± 8.5 cm3/s, respectively. Calculated flow rates through the bioprosthesis correlated well but underestimated true flow, with r = 0.97, ΔQ = −10.9 ± 12.5 cm3/s, suggesting flow convergence over an >2π. This systematic underestimation was corrected by assuming an effective convergence angle of 212 δ.Conclusions. This algorithm accurately locates the regurgitant orifice and calculates regurgitant flow rate for circular orifices with planar surroundings. Automated analysis of the proximal flow field is also applicable to more physiologic surfaces surrounding the regurgitant orifice; however, the convergence angle should be adjusted. This automated algorithm should make quantification of regurgitant flow rate and regurgitant orifice area more reproducible and readily available in clinical cardiology practice

Patterns of normal transvalvular regurgitation in mechanical valve prostheses

AbstractThe magnitude and spatial distribution of normal leakage through mechanical prosthetic valves were studied in an in vitro model of mitral regurgitation. The effective regurgitant orifice was calculated from regurgitant rate at different transvalvular pressure differences and flow velocities. This effective orifice area was 0.6 to 2 mm2for three tilting disc prostheses (Medtronic-Hall sizes 21, 25 and 29) and 0.2 to 1.1 mm2for three bileaflet valves (St. Jude Medical sizes 21, 25 and 33).In the single disc valves, Doppler color flow examination disclosed a prominent central regurgitant jet around the central hole for the strut, accompanied by minor leakage along the rim of the disc (central to peripheral jet area ratio 3.3 ± 1.2). The bileaflet prostheses showed a peculiar complex pattern: in planes parallel to the two disc axes, convergent peripherally arising jets were visualized, whereas in orthogonal planes several diverging jets were seen.Mounting the disc and bileaflet valves on a water-filled tube allowed reproduction and interpretation of this pattern: for the bileaflet valve, the jets originated predominantly from valve ring protrusions that contained the axis hinge points and created a converging V pattern in planes parallel to the leaflets and a diverging V pattern in orthogonal planes.Similar patterns were observed during transesophageal echocardiography in 20 patients with a normally functioning St. Jude prosthesis. In 10 patients with a Medtronic-Hall valve, a dominant central jet was observed with one or more smaller peripheral jets. The median central to peripheral jet area ratio was 5 to 1.In summary, in two types of mechanical valve prostheses, effective leakage orifice areas are reported and criteria proposed for the differentiation of “physiologic” and pathologic regurgitation based on the spatial configuration of the jets

Echocardiographic assessment of patients with infectious endocarditis: Prediction of risk for complications

AbstractTo enhance the echocardiographic identification of high risk lesions in patients with infectious endocarditis, the medical records and two-dimensional echocardiograms of 204 patients with this condition were analyzed. The occurrence of specific clinical complications was recorded and vegetations were assessed with respect to predetermined morphologic characteristics.The overall complication rates were roughly equivalent for patients with mitral (53%), aortic (62%), tricuspid (77%) and prosthetic valve (61%) vegetations, as well as for those with nonspecific valvular changes but no discrete vegetations (57%), although the distribution of specific complications varied considerably among these groups. There were significantly fewer complications in patients without discernible valvular abnormalities (27%).In native left-sided valve endocarditis, vegetation size, extent, mobility and consistency were all found to be significant univariate predictors of complications. In multivariate analysis, vegetation size, extent and mobility emerged as optimal predictors and an echocardiographic score based on these factors predicted the occurrence of complications with 70% sensitivity and 92% specificity in mitral valve endocarditis and with 76% sensitivity and 62% specificity in aortic valve endocarditis

A two-dimensional numerical model of dry convection with three-dimensional dynamics

Due to the character of the original source materials and the nature of batch digitization, quality control issues may be present in this document. Please report any quality issues you encounter to [email protected], referencing the URI of the item.Bibliography: leaves 55-57.Not availabl

A research strategy for the Pacific climate information system

For more about the East-West Center, see http://www.eastwestcenter.org/Based on a selective review of the outcomes of previous meetings, conferences, workshops, and papers highlighting climate variability and change research needs in the Pacific region, this paper presents a research strategy for increasing understanding of climate-society linkages in Pacific Island settings. The strategy provides a synopsis of emerging research goals and illustrative activities that users can rank according to their priorities. Grounded in the framework of the Pacific Climate Information System, the strategy is comprised of three key research elements: (1) research to enhance understanding of regional climate risks and consequences; (2) research to improve decision support and risk communication; and (3) research to improve climate adaptation capacity. We envision the strategy will contribute to enhanced understanding of scientific and societal knowledge of climate processes and their impacts and stakeholder capacity for building sustainable island communities for future generations

CAN SIMPLE EXPERIMENTAL ELECTRONICS SIMULATE THE DISPERSAL PHASE OF SPIDER BALLOONERS?

Volume: 33Start Page: 523End Page: 53

Calculation of atrioventricular compliance from the mitral flow profile: analytic and in vitro study

AbstractThe quantitative assessment of ventricular diastolic function is an important goal of Doppler echocardiography. Hydrodynamic analysis predicts that the net compliance (Cn) or the left atrium and ventricle can be quantitatively predicted from the deceleration rate (dvdt) of the mitral velocity profile by the simple expression: Cn= − Aϱdt where A is effective mitral valve area and ϱ is blood density.This formula was validated using an in vitro model of transmitral filling where mitral valve area ranged from 0.5 to 2.5 cm2and net compliance from 0.012 to 0.023 cm3/(dynes/cm2) (15 to 30 cm3/mm Hg). In 34 experiments in which compliance was held constant throughout the filling period, net atrioventricular compliance was accurately calculated from the E wave downslope and mitral valve area (r = 0.95, p < 0.0001).In a second group of experiments, chamber compliance was allowed to vary as a function of chamber pressure. When net compliance decreased during diastole (as when the ventricle moved to a steeper portion of its pressure-volume curve), the transorifice velocity profile was concave downward, whereas when net compliance increased, the velocity profile was concave upward. Application of the preceding formula to these curved profiles allowed instantaneous compliance to be calculated throughout the filling period (r = 0.93, p < 0.001). Numeric application of a mathematic model of mitral filling demonstrated the accuracy of this approach in both restrictive and nonrestrictive orifices.It is concluded that 1) net compliance can be calculated noninvasively and quantitatively from mitral valve area and E wave downslope, and 2) the time course of net compliance determines the shape of the downslope: concave downward profiles indicate decreasing compliance whereas concave upward profiles indicate increasing compliance