Wilkins G T, Gillam L D, Kritzer G L, Levine R A, Palacios I F, Weyman A E
Circulation. 1986 Oct;74(4):786-95. doi: 10.1161/01.cir.74.4.786.
For patients with stenotic native valves, the modified Bernoulli equation (delta P = 4V2) may be applied to Doppler-measured transvalvular velocities to yield an accurate estimate of transvalvular gradients. Although it would be useful if the same approach could be used for those with stenotic prosthetic valves, no previous study has validated the Doppler technique in this setting. We therefore recorded simultaneous continuous-wave Doppler flow profiles and transvalvular manometric gradients in 12 catheterized patients in whom all atrial and ventricular pressures were directly measured (transseptal left atrial catheterization and transthoracic ventricular puncture were performed where necessary). A total of 13 prostheses were studied: 11 mitral (seven porcine, three Starr-Edwards, and one Björk-Shiley) and two tricuspid (one porcine and one Björk-Shiley). The Doppler-determined mean gradient was calculated as the mean of the instantaneous gradients (delta P = 4V2) at 10 msec intervals throughout diastole. The correlation of simultaneous Doppler (DMG) and manometric mean gradients (MG) for the whole group (n = 13) demonstrated a highly significant relationship (MG = 1.07 DMG + 0.28; r = .96, p = .0001). The correlation was equally good for porcine valves alone (n = 8) (MG = 1.06 DMG + 0.55; r = .96, p = .001) and for mechanical valves alone (n = 5) (MG = 1.06 DMG - 0.04; r = .93, p = .02). In a subset of patients without regurgitation (n = 8), prosthetic valve areas were estimated by two Doppler methods originally described by Holen and Hatle, as well as by the invasive Gorlin method. As expected from theoretical considerations, a close correlation was not demonstrated between results of the Gorlin method and those of either Hatle's Doppler method (r = .65, fp = NS) or Holen's method (r = .14, p = NS). Comparison of the results of the two Doppler methods yielded a somewhat closer correlation (r = .73, p less than or equal to .05). These results suggest that in patients with disk-occluder, ball-occluder, and porcine prosthetic valves, Doppler estimates of transvalvular gradients are virtually identical to those obtained invasively.
对于患有狭窄天然瓣膜的患者，改良的伯努利方程（ΔP = 4V²）可应用于多普勒测量的跨瓣膜速度，以准确估计跨瓣膜压差。尽管对于患有狭窄人工瓣膜的患者使用相同方法会很有用，但之前尚无研究在这种情况下验证多普勒技术。因此，我们记录了12例接受导管插入术患者的同步连续波多普勒血流剖面图和跨瓣膜测压压差，这些患者的所有心房和心室压力均直接测量（必要时进行经房间隔左心房导管插入术和经胸心室穿刺）。共研究了13个人工瓣膜：11个二尖瓣（7个猪生物瓣、3个Starr-Edwards瓣和1个Björk-Shiley瓣）和2个三尖瓣（1个猪生物瓣和1个Björk-Shiley瓣）。多普勒测定的平均压差计算为整个舒张期以10毫秒间隔的瞬时压差（ΔP = 4V²）的平均值。整个组（n = 13）同步多普勒（DMG）和测压平均压差（MG）的相关性显示出高度显著的关系（MG = 1.07 DMG + 0.28；r = 0.96，p = 0.0001）。单独对于猪生物瓣（n = 8）（MG = 1.06 DMG + 0.55；r = 0.96，p = 0.001）和单独对于机械瓣（n = 5）（MG = 1.06 DMG - 0.04；r = 0.93，p = 0.02），相关性同样良好。在无反流的患者亚组（n = 8）中，通过最初由Holen和Hatle描述的两种多普勒方法以及侵入性的Gorlin方法估计人工瓣膜面积。正如从理论考虑所预期的那样，Gorlin方法的结果与Hatle的多普勒方法（r = 0.65，fp = 无显著性差异）或Holen方法（r = 0.14，p = 无显著性差异）的结果之间未显示出密切相关性。两种多普勒方法结果的比较产生了稍紧密一些的相关性（r = 0.73，p≤0.05）。这些结果表明，对于带有盘式阻塞器、球式阻塞器和猪生物瓣的患者，多普勒对跨瓣膜压差的估计实际上与侵入性获得的估计相同。
