Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
J Am Soc Echocardiogr. 2018 Dec;31(12):1353-1365. doi: 10.1016/j.echo.2018.08.015. Epub 2018 Oct 16.
In the 1970s, as cardiac imaging matured from M-mode to two-dimensional echocardiography, investigators in Norway showed that continuous-wave Doppler ultrasonography could be used to accurately measure the mean gradient and pressure half-time for stenotic mitral valves. In the 1980s, continuous-wave Doppler was validated for measurement of the pressure gradient across stenotic aortic valves, and pulsed-wave Doppler combined with two-dimensional echocardiographic imaging was validated for noninvasive measurement of stroke volume and cardiac output. The combination of stroke volume measurement and measurement of the time-velocity integral of flow through the aortic valve was then validated as a means to accurately calculate valve area for patients with stenotic aortic valves or aortic prostheses. This integration of cardiac Doppler ultrasonography with two-dimensional echocardiographic cardiac imaging led to a revolution in noninvasive hemodynamic evaluations, which have replaced invasive hemodynamic evaluations in surgical decision making for most patients with native or prosthetic valvular stenosis.
20 世纪 70 年代，随着心脏成像技术从 M 模式发展到二维超声心动图，挪威的研究人员表明，连续波多普勒超声可以准确测量狭窄二尖瓣的平均梯度和压力减半时间。20 世纪 80 年代，连续波多普勒技术被验证可用于测量狭窄主动脉瓣的压力梯度，脉冲波多普勒结合二维超声心动图成像被验证可用于无创测量心搏量和心输出量。随后，通过测量主动脉瓣血流的速度时间积分的搏动波多普勒与心搏量测量相结合，被验证为一种准确计算狭窄主动脉瓣或主动脉瓣假体患者瓣口面积的方法。这种将心脏多普勒超声与二维超声心动图心脏成像相结合的方法，引发了非侵入性血流动力学评估的革命，它已经取代了大多数患有原发性或假体瓣膜狭窄的患者的手术决策中的有创血流动力学评估。
