Enriquez-Sarano M, Seward J B, Bailey K R, Tajik A J
Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905.
J Am Coll Cardiol. 1994 Feb;23(2):443-51. doi: 10.1016/0735-1097(94)90432-4.
The purpose of this study was to determine the feasibility, relation to other methods and significance of the effective regurgitant orifice area measurement.
Assessment of the severity of valvular regurgitation (effective regurgitant orifice area) has not been implemented in clinical practice but can be made by Doppler echocardiography.
Effective regurgitant orifice area was calculated by Doppler echocardiography as the ratio of regurgitant volume/regurgitant jet time-velocity integral and compared with color flow Doppler mapping, angiography, surgical classification, regurgitant fraction and variables of volume overload.
In 210 consecutive patients examined prospectively, feasibility improved from the early to the late experience (65% to 95%). Effective regurgitant orifice area was 28 +/- 23 mm2 (mean +/- SD) for aortic regurgitation (32 patients), 22 +/- 13 mm2 for ischemic/functional mitral regurgitation (50 patients) and 41 +/- 32 mm2 for organic mitral regurgitation (82 patients). Significant correlations were found between effective regurgitant orifice and mitral jet area by color flow Doppler mapping (r = 0.68 and r = 0.63, p < 0.0001, respectively) and angiographic grade (r = 0.77, p = 0.0004). Effective regurgitant orifice area in surgically determined moderate and severe lesions was markedly different in mitral regurgitation (35 +/- 12 and 75 +/- 33 mm2, respectively, p = 0.009) and in aortic regurgitation (21 +/- 8 and 38 +/- 5 mm2, respectively, p = 0.08). Strong correlations were found between effective regurgitant orifice area and variables reflecting volume overload. A logarithmic regression was found between effective regurgitant orifice area and regurgitant fraction, underlining the complementarity of these indexes.
Calculation of effective regurgitant orifice area is a noninvasive Doppler development of an old hemodynamic concept, allowing assessment of the lesion severity of valvular regurgitation. Feasibility is excellent with experience. Effective regurgitant orifice area is an important and clinically significant index of regurgitation severity. It brings additive information to other quantitative indexes and its measurement should be implemented in the comprehensive assessment of valvular regurgitation.
本研究旨在确定有效反流口面积测量的可行性、与其他方法的关系及其意义。
瓣膜反流严重程度（有效反流口面积）的评估尚未在临床实践中实施，但可通过多普勒超声心动图进行测量。
通过多普勒超声心动图计算有效反流口面积，即反流容积与反流束时间-速度积分的比值，并与彩色多普勒血流图、血管造影、手术分级、反流分数及容量超负荷变量进行比较。
在210例连续接受前瞻性检查的患者中，可行性从早期到后期经验有所提高（65%至95%）。主动脉反流（32例患者）的有效反流口面积为28±23mm²（均值±标准差），缺血性/功能性二尖瓣反流（50例患者）为22±13mm²，器质性二尖瓣反流（82例患者）为41±32mm²。彩色多普勒血流图显示有效反流口与二尖瓣反流束面积之间存在显著相关性（r分别为0.68和0.63，p<0.0001），与血管造影分级也存在显著相关性（r = 0.77，p = 0.0004）。手术确定的中重度二尖瓣反流和主动脉反流病变的有效反流口面积明显不同（二尖瓣反流分别为35±12和75±33mm²，p = 0.009；主动脉反流分别为21±8和38±5mm²，p = 0.08）。有效反流口面积与反映容量超负荷的变量之间存在强相关性。有效反流口面积与反流分数之间存在对数回归关系，强调了这些指标的互补性。
有效反流口面积的计算是一种基于古老血流动力学概念的无创多普勒技术，可用于评估瓣膜反流病变的严重程度。随着经验积累，可行性极佳。有效反流口面积是反流严重程度的一个重要且具有临床意义的指标。它为其他定量指标提供了补充信息，其测量应在瓣膜反流的综合评估中实施。
