Veyrat C, Abitbol G, Bas S, Manin J P, Kalmanson D
Ultrasound Med Biol. 1984 Mar-Apr;10(2):201-13. doi: 10.1016/0301-5629(84)90219-9.
It is now possible with pulsed Doppler to grade the severity of aortic, mitral and tricuspid regurgitations on a quantitative basis. "Indices" were devised, using the measurement of the spatial extent of abnormal Doppler signals. For aortic regurgitation: (1) at the aortic valvular orifice area, by measurement of the regurgitant aortic valvular area and calculation of the valvular regurgitant "index". (2) In the left ventricle outflow tract, by calculation of an "index" combining information from two echographic (short and long axis) planes. For mitral regurgitation: by calculation of the total regurgitant "index" combining information from examination of the annulus in short axis, and of the left atrium in long axis view. For tricuspid regurgitation: at the tricuspid annulus, by averaging the depth of the reversal wave on two samples recorded using various echographic approaches. A group of patients with aortic (42), mitral (55) and tricuspid (57) regurgitation proven by invasive procedures, was investigated with this procedure using a 3 MHz two dimensional pulsed Doppler echo device. Correlative coefficients between the Doppler grading and that provided by independently performed invasive procedures on a three point scale, ranged between 0.66 and 0.88, with significant differentiation of mean values of indices (P less than 0.01 to P less than 0.001) for each grade of severity. Success in the Doppler grading of severity of the regurgitations requires (1) a sampling as close as possible to the lesion, and optimally at ther very site of the lesion, (2) the largest explorable area at the site of the lesion, (3) the relevancy of the selected Doppler parameter in order to take into account, as much as possible, the three dimensional configuration of the regurgitant jet. Moreover, this mapping procedure provides a pathophysiological insight of the regurgitant lesion for left-sided regurgitations.
现在，使用脉冲多普勒可以在定量基础上对主动脉瓣、二尖瓣和三尖瓣反流的严重程度进行分级。利用异常多普勒信号空间范围的测量设计了“指数”。对于主动脉瓣反流：（1）在主动脉瓣口面积处，通过测量反流的主动脉瓣面积并计算瓣膜反流“指数”。（2）在左心室流出道，通过结合两个超声心动图（短轴和长轴）平面的信息计算“指数”。对于二尖瓣反流：通过结合短轴环和长轴左心房检查信息计算总反流“指数”。对于三尖瓣反流：在三尖瓣环处，通过对使用各种超声心动图方法记录的两个样本上反流波深度求平均值。一组经侵入性检查证实患有主动脉瓣反流（42例）、二尖瓣反流（55例）和三尖瓣反流（57例）的患者，使用3兆赫二维脉冲多普勒超声装置进行了该检查。多普勒分级与独立进行的侵入性检查在三点量表上提供的分级之间的相关系数在0.66至0.88之间，各严重程度等级的指数平均值有显著差异（P小于0.01至P小于0.001）。反流严重程度的多普勒分级成功需要（1）尽可能靠近病变进行采样，最好在病变部位本身，（2）病变部位最大可探测区域，（3）所选多普勒参数的相关性，以便尽可能考虑反流束的三维结构。此外，这种映射程序为左侧反流病变提供了病理生理学见解。
