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J Thorac Cardiovasc Surg 2001;122:287-295
© 2001 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease (ACD)

Assessment of effective orifice area of prosthetic aortic valves with Doppler echocardiography: An in vivo and in vitro study

From the Department of Clinical Physiology, Sahlgrenska University Hospital,^a and the Departments of Biomedical Engineering^b and Clinical Physiology,^c Linköping University Hospital, Göteborg, Sweden.

This study was supported by Vingmed GE Sound, Horten, Norway, and by grants from the Göteborg Medical Society, Sahlgrenska University Hospital, the Swedish Heart and Lung Foundation, Swedish Medical Society, St Jude Medical, Inc, St Paul, Minn, MedicalCV, Incorporated, Inver Grove Heights, Minn, and Västra Götalandregionen.

Received for publication Dec 19, 2000. Revisions requested Jan 22, 2001; revisions received Feb 5, 2001. Accepted for publication Feb 12, 2001. Address for reprints: Odd Bech-Hanssen, MD, PhD, Department of Clinical Physiology, Sahlgrenska University Hospital, SE-413 45 Göteborg, Sweden (E-mail: odd.bech-hanssen{at}klinfys.gu.se).

Abstract

Objectives: We sought to evaluate the Doppler assessment of effective orifice area in aortic prosthetic valves. The effective orifice area is a less flow-dependent parameter than Doppler gradients that is used to assess prosthetic valve function. However, in vivo reference values show a pronounced spread of effective orifice area and smaller orifices than expected compared with the geometric area.
Methods: Using Doppler echocardiography, we studied patients who received a bileaflet St Jude Medical valve (n = 75; St Jude Medical, Inc, St Paul, Minn) or a tilting disc Omnicarbon valve (n = 46; MedicalCV, Incorporated, Inver Grove Heights, Minn). The prosthetic valves were also investigated in vitro in a steady-flow model with Doppler and catheter measurements in the different orifices. The effective orifice area was calculated according to the continuity equation.
Results: In vivo, there was a wide distribution with the coefficient of variation (SD/mean x 100%) for different valve sizes ranging from 21% to 39% in the St Jude Medical valve and from 25% to 33% in the Omnicarbon valve. The differences between geometric orifice area and effective orifice area in vitro were 1.26 ± 0.41 cm² for St Jude Medical and 1.17 ± 0.38 cm² for Omnicarbon valves. The overall effective orifice areas and peak catheter gradients were similar: 1.35 ± 0.37 cm² and 25.9 ± 16.1 mm Hg for St Jude Medical and 1.46 ± 0.49 cm² and 24.6 ± 17.7 mm Hg for Omnicarbon. However, in St Jude Medical valves, more pressure was recovered downstream, 11.6 ± 6.3 mm Hg versus 3.4 ± 1.6 mm Hg in Omnicarbon valves (P = .0001).
Conclusions: In the patients, we found a pronounced spread of effective orifice areas, which can be explained by measurement errors or true biologic variations. The in vitro effective orifice area was small compared with the geometric orifice area, and we suspect that nonuniformity in the spatial velocity profile causes underestimation. The St Jude Medical and Omnicarbon valves showed similar peak catheter gradients and effective orifice areas in vitro, but more pressure was recovered in the St Jude Medical valve. The effective orifice area can therefore be misleading in the assessment of prosthetic valve performance when bileaflet and tilting disc valves are compared.

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