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Biomedical subjects

D Kalmanson

Publications and source records attributed to D Kalmanson.

At least 19 recordsLinked to original sources
PubMed1996

Colour doppler valvar and subvalvar flow diameter imaging versus echo score in mitral stenosis: comparison with type of surgery.

OBJECTIVE: To compare the value of echo score with that of Doppler subvalvar flow broadening in deciding the type of mitral stenosis surgery. PATIENTS: 30 patients, mean age 47 years, with severe stenosis undergoing surgery were divided into two groups according to type of surgery: open heart commissurotomy (group 1, n = 12), or prosthesis (group 2, n = 18). A control group of 10 patients with prosthesis served as reference, representing mild stenosis without subvalvar connection. METHODS: For echo, the score proposed by Wilkins for cross sectional imaging was used. For Doppler, the flow diameters were measured in cm by an independent examiner from the long axis view in early diastole at two levels: (1) at the level of the stenosis (origin flow diameter), and (2) 1.5 cm downstream from the stenosis in the left ventricle (subvalvar flow diameter) with calculation of a Doppler ratio relating these two measurements, expressed as a percentage of broadening. Diagnostic value was compared for both procedures. RESULTS: There was no significant difference in age, mitral valve areas, or haemodynamics for the two groups. Mean values (SD) were: echo score: group 1, 9.83 (1.26) v group 2, 10.8 (8.1), NS; Doppler ratio %: group 1, 44 (24) v group 2, 12 (21) (P < 0.001); control group: 69 (15). The per cent diagnostic value for an open heart commissurotomy of respective cut off points was: Doppler ratio > 25% (range 71% to 87%); echo score < 10 (range 50% to 75%). CONCLUSIONS: The new Doppler ratio diagnostic value agreed better with surgical management, repair or prosthesis, in this study. Thus, it appears to better reflect the subvalvar involvement and changes in kinetics than the echo score alone. This easy Doppler method might become a routine examination for follow up of patients with open heart commissurotomy, to avoid performing repeated transoesophageal echocardiography.

Adolescent↗
PubMed1994

A new Doppler imaging measurement in aortic stenosis: the contour length of the jet origin flow area. Relationships between both, with usual Doppler data and left ventricular hypertrophy.

Planimetry of stenotic aortic jet origin flow areas was performed using transthoracic Doppler imaging, with measurement of the contour length of flow areas and calculation of a contour/area (C/A) Doppler ratio on a group of 75 patients with aortic stenosis ranging from 0.27 to 2.44 cm2. The purpose was to study correlations of these data with the usual Doppler data and with left ventricular hypertrophy. The "r" coefficient between planimetered flow areas and those calculated by the continuity equation method was 0.89. Mean values (SD) of data were: areas: (planimetry) 1.00 +/- 0.53 cm2, (continuity equation) 0.91 +/- 0.42 cm2, contours: 5.6 +/- 1.6 cm, C/A: 0.66 +/- 0.25, maximal and mean pressure gradients: 68 +/- 34 and 37 +/- 21 mmHg, left ventricular hypertrophy: 138 +/- 30 g/m2 BSA (vs. 100 +/- 18 in normals). All values except age, gender and BSA, differed significantly (p < 0.001) between areas below or over 0.85 cm2. Other correlations between parameters were significant (p < 0.01 to 0.001), but with lower "r" coefficients due to widely scattered individual values. Contours increased much less rapidly than areas did, and were correlated with left ventricular hypertrophy only when coupled in the C/A ratio, with a higher "r" coefficient (0.62) than areas alone (0.52). Study of both areas and contours helps to approach the geometry of the orifice. This suggests that the individual geometry of the stenosis might weigh on the left ventricular mass growth, as an associated factor for a given decrease in stenotic area.

Adult↗
PubMed1994

Relationships between contour and/or contour/area ratio at Doppler and left ventricular hypertrophy in patients with significant aortic stenosis.

Planimetry of the stenotic flow areas using Doppler imaging of jet origin was performed, together with the measurement of their contour and a calculated contour/area (C/A) Doppler ratio, on 38 adult patients with significant aortic stenosis (0.27 to 0.85 cm2). Echo measurements of left ventricular hypertrophy (LVH) were also performed to study the differences in LVH according to the areas, even in case of smaller areas. This led to lower mean values of LVH (p < 0.001) in this group, and to a correlation coefficient at 0.18. The smallest areas were generally rounded and had a high C/A ratio. Contour was regular in half of areas over 0.5 cm2. It increased less rapidly than areas increased, leading to a decreased C/A. The other half, of a similar range of sizes, had a markedly increased irregular contour, entailing a C/A > 0.8. The highest mean value in LVH was found in this subgroup. Correlation coefficients vs. LVH were 0.43 for contour, and 0.32 for C/A ratio. Diagnostic reliability of a C/A > 0.8 for an LVH > 150 g/m2 BSA ranged from 55 to 70%. In conclusion, the study suggests that contour length weighs on LVH development when stenoses are significant, and should be coupled with area measurements. Figures also suggest that other factors intervene, requiring further study.

Adult↗
PubMed1994

[Time changes of mitral regurgitant jets: a 4th dimension for Doppler evaluation of the severity of mitral regurgitation].

The quantitation of mitral regurgitation is based on measurement of the maximal jet area by colour flow mapping. Discrepancies have been reported with the possibility of significant temporal variations of jet size. The aim of this study was to determine whether evaluation could be improved by taking these variations into consideration. Three dimensional Doppler colour flow mapping by combining measurements of length, height and width of the jet in two orthogonal planes, in order to obtain a global index of regurgitation, was undertaken in 40 patients with angiographically documented mitral regurgitation classified in three degrees, mild, moderate and severe. Two-dimensional Doppler with colour M-mode was performed in each patient analysing early, mild and late systole. In the absence of significant temporal variation, assessment was based on measurement of maximal jet area alone (maximum global regurgitation index). When there were significant temporal variations, the index was calculated during each phase of systole and the values averaged to obtain a mean global regurgitation index. Temporal variations were observed in 14 of the 40 patients (35%), mainly in mild and moderate regurgitation. Significant differences were noted in the values of maximal (p < 0.01 to 0.001) and mean global regurgitation indices (p < 0.001 to 0.0001) between each degree of severity. A paired study demonstrated significant differences between the two indices in mild (p < 0.01) and moderate regurgitation (p < 0.05). Assessment of the severity of mitral regurgitation was satisfactory in 65% of cases using the maximal global regurgitation index with 14 overestimations, all in cases of mild and moderate regurgitation.(ABSTRACT TRUNCATED AT 250 WORDS)

Echocardiography, Doppler↗
PubMed1993

Direction, site of origin and duration of jets: implications in the color Doppler assessment of valvar lesions. With emphasis on pure and combined mitral and bicuspid aortic lesions.

Color Doppler imaging has renewed and widened the capabilities of the flow mapping technique. In addition to its facilitation, it has some specific advantages: by showing the spatio-temporal variations of jets within the cardiac cycle, it provides a quadri-dimensional insight into flow dynamics, which has improved the semi-quantitative assessment of the severity in mitral regurgitation by taking into account the duration of the regurgitant jet within systole. It is also crucial for the study of multiple jets often seen in combined mitral disease and related to various diseased components of the mitral apparatus. Peculiar features of sites, directions and timings of jets enable the recognition of their mechanisms and draw the attention to a possible surface adherence effect, in the case of complicated trajectories impinging on the cardiac structures. Color Doppler imaging is also unique in singling out the precise site where the jets originate. This leads to developments of quantitation of stenosis based on planimetry of jet origin areas and to new quantitative methods relying on flow convergence information on one hand, and on the other hand, it helps approach to special lesional mechanisms such as, for instance bicuspid aortic valves, easily singled out by flow information from tricuspid aortic valves. This information will be crucial in the discussion of the type of repair procedure in the future.

Aortic Valve Insufficiency↗
PubMed1991

[Characteristics of jets in adult bicuspid aortic valve by color Doppler imaging].

Color flow mapping of 15 adults with bicuspid aortic valves confirmed angiographically and at surgery comprising 8 regurgitations and 7 stenoses was analysed, retrospectively in 12 cases. The object was to detect any special features of the jets of this congenital abnormality. The site of emergence of the jet at the aortic orifice and its direction in the left ventricle were studied in the long axis, short transaortic and left ventricular axes by sequential analysis. Two types of regurgitant jet were observed: eccentric anterior origin (5, Type I), eccentric posterior origin (3, Type II), extending towards the structure opposite to their origin in the left ventricular outflow tract. In cases of stenosis, the cross-sectional view of the jet had an almost transverse slit-like appearance extending from one side of the aortic orifice to the other or an anterior or posterior eccentric oval shape. The Type I cases and the slit-like anterior stenoses had fusion of the coronary cusps whilst the Type II and posterior slit-like stenoses had fusion of the right coronary and non-coronary cusps. This preliminary study suggests that bicuspid aortic valves are associated with jet characteristics related to the abnormal commissural axis which allows diagnosis and precision of the anatomic type in adults despite the presence of calcification.

Adult↗
PubMed1991

[Chronology of maximal surface area and peak velocities of left heart valve flow jets using Doppler imaging. Clinical implications].

The aim of this study was to correlate the timing of the maximal surface area of the jet recorded by color flow Doppler and the peak velocities recorded by continuous mode Doppler with reference to the ECG R wave to determine whether standardisation of the chronologies of measurements was possible. A comparative paired study of these two parameters was undertaken in 44 subjects who had 55 left heart valvular lesions, all in sinus rhythm and, in cases of regurgitation, with pansystolic or pandiastolic regurgitant flow. The jets were examined in the inflow chambers of valvular insufficiency and at the origin of the jet in the short axis for stenotic lesions and aortic regurgitation, with planimetry of the cross sectional area in color Doppler. The correlation coefficient was 0.85 for aortic stenosis, 0.96 for mitral stenosis, 0.84 for aortic regurgitation but only 0.10 for mitral regurgitation. The mean values of the two chronologies were identical for stenotic lesions and did not differ significantly in regurgitation even at the mitral valve. However, the individual differences between the two chronologies exceeded 20 ms in 63% of aortic and 91% of mitral regurgitations. The maximal surface areas of the jets of 45% of aortic regurgitant and 91% of mitral regurgitant lesions were recorded between the onset of regurgitation and the peak jet velocity. The differences in chronology of the two parameters studied in cases of valvular regurgitation indicate the multifactorial nature of color flow jet imaging, probably associated with individual physiopathological variations.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Quantification of left-sided valvular stenoses by color Doppler imaging of jets.

A new methodology for assessment of severity of stenosis employing color Doppler imaging and relying upon spatial and temporal studies of aortic and mitral stenotic jets is described. The spatial study consisted of the detection of the jet origin with respect to upstream and downstream trajectories in the long-axis view, with further identification of each of the three levels from characteristics single-gated Doppler flow recordings, when desired. For the temporal study, color images were gated in midsystole for aortic, and in early diastole for mitral, stenosis. The final step consisted of imaging the jet cross-sectional area in the short-axis view with planimetry. Measurements were compared with those obtained by the Gorlin formula. The procedure was feasible in 43 of 48 studied cases and the correlation between hemodynamic and color Doppler data was satisfactory for both valvular lesions. The best agreement between both methods was for severe stenoses, where the standard error of estimate was the lowest. For large areas the variance in measurements was wider and the correlation coefficient decreased, but this did not cause errors in recognition. This new method provides a convenient and rapid visualization of stenotic jets and is particularly recommended for assessment of severe stenoses, where accuracy was highest for all clinical conditions.

Aortic Valve Stenosis↗
PubMed1990

[Changes in mitral and tricuspid blood flow as a function of aging. Value of a combined study with Doppler echocardiography].

The many factors, especially physiological, which influence mitral diastolic flow and the difficulties in interpretation motivated this study of age related changes of blood flow through the two atrioventricular orifices, taking tricuspid flow as the reference for evaluation of any change in mitral flow. Doppler echocardiographic studies were performed in 45 normal subjects who were divided into 3 groups according to age. The amplitude, duration and velocity time integrals (VTI) of the E and A waves were studied at the level of the valve rings and at the tips of the leaflets. Ventricular isovolumic relaxation periods were measured. The following age-related changes were observed at both atrioventricular valve orifices: increased amplitude and VTI of the A waves; decreased amplitude and VTI of the E waves, leading to a decrease or inversion of the ratios of the E/A wave amplitudes and VTI. No significant differences in the duration of the E and A waves were detected. An increase in the left ventricular isovolumic relaxation period was observed. Differences were also recorded according to the site of the Doppler sample volume: increased amplitude, duration and VTI of the E and A waves when the flow was recorded at the tips of the valve leaflets. This underlines the value of using the E wave VTI/total VTI ratio which was unaffected by the sample volume position. An age-related decrease in this ratio was demonstrated at both atrioventricular valve orifices.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1989

[A new quantitative method for quantifying left heart jets by Doppler color imaging].

Quantification of valvular lesions by Color Doppler is based on jet measurements. The aim of this new method is to reduce some of the errors in these measurements: uncertainty in delimiting the colored areas of the jets; spontaneous beat-to-beat variations of the jets entailing interpretative difficulties. The first step was to determine the correlations between the colored areas and previously established single-gated Doppler criteria, retaining spectral criteria to define the borders of the jets, so overcoming some of the limitations of color Doppler. The association of these methods resulted in better discrimination between grades and a better correlation in 45 angiographically controlled mitral and aortic regurgitations than with color Doppler alone. In stenotic lesions, spectral criteria from single-gated associated exploration enabled localisation of the level for planimetry of the section of the jet at its origin visualised by color Doppler. Satisfactory correlations were obtained with the Gorlin surface area in a group of 43 patients with mitral and aortic stenosis. A coefficient of variation of 13 to 14 per cent was found with planimetry of the regurgitant jet in the upstream cardiac chamber. Uni-dimensional measurement decreased this variation to 6 to 11 per cent in the same patients. The largest decrease in variability (6 to 8 per cent) was observed in stenotic and regurgitant lesions with planimetry of the section of jet at its origin performed in held mid-expiration and so this would appear to be the best method. The guide lines and technological improvement associated with the physiopathological information provided by color Doppler should refine the quantification of valvular heart lesions.

Adult↗
PubMed1988

Doppler flow mapping and its comparison with the continuity equation method for quantifying aortic stenosis.

The flow-mapping technique, which detects and planimeters the area of systolic flow at the site of the aortic orifice, was applied to 59 patients with a stenosed aortic valve, all of whom underwent cardiac catheterization. The success rate was 93%. The correlation coefficient between the values of valvular areas obtained by Doppler and those yielded by the Gorlin formula was r = 0.93 (SEE = 0.12 cm2). The continuity equation procedure, with the use of the velocity-time integrals, was applied sequentially to 20 of the above mentioned patients. The success rate was 85%. The valvular areas obtained in these patients by the Gorlin formula correlated well with those obtained with flow mapping (r = 0.90, SEE = 0.14, standard deviation of the difference = 0.13 cm2), as well as with those yielded by the continuity equation procedure (r = 0.86, SEE = 0.17 cm2, standard deviation of the difference = 0.16 cm2). Furthermore, the data from both ultrasonic methods were satisfactorily cross-correlated (r = 0.92, SEE = 0.12 cm2). It is noteworthy that the values of aortic valvular area obtained by Doppler were slightly larger than those found using either the continuity equation procedure or the Gorlin formula. The authors conclude that the flow-mapping technique represents a reliable method for quantifying stenotic aortic valvular area and correlates well with the continuity equation procedure. It is therefore suggested that, whenever possible, both techniques should be used sequentially as a valuable and practical cross-checking policy.

Aortic Valve Stenosis↗
PubMed1987

Application of Doppler flow mapping in assessing the severity of mitral stenosis.

The purpose of the flow mapping procedure is to pick up flow signals related to jets at the site of lesions, in order to delineate the cross-section of the jets. The pulsed Doppler procedure was applied to a group of 33 consecutive patients with mitral stenosis confirmed invasively in all cases and by surgery in 15 cases. The examination involved the recording of flow signals at the distal edge of the mitral oriface investigated in the short-axis view. Doppler criteria for required flow signals were the presence of a high-pitched tone and of a laminar spectrum, occurring at a definite timing in early to mid-diastole, i.e. at the period of the maximal atrioventricular pressure gradient. Planimetry of the flow area was performed and correlated with haemodynamic data using the Gorlin formula. The procedure was applicable in 32/33 patients. The correlation coefficient was 0.94, standard error of estimate 0.13 cm2, P less than 0.001. The mean difference between invasive and non-invasive measurements was -0.04 +/- 0.14 cm2 and the standard error of the mean 0.03 cm2. This new application of flow mapping provided reliable information for the later surgical procedure. It should benefit in future from improvements in spatial resolution and in signal to noise ratio.

Humans↗
PubMed1987

Detection of diastolic mitral regurgitation using pulsed Doppler and its implications.

Diastolic mitral regurgitation has been angiographically demonstrated in some patients with severe aortic regurgitation and/or nonobstructive cardiomyopathy. The purpose of this paper was two-fold: to study the feasibility of pulsed Doppler noninvasive detection of this unusually timed regurgitation on the basis of angiographic correlations in a group of 21 patients with such conditions and sinus rhythm with normal PR interval in 81% of the cases, and when diastolic mitral regurgitation was present, to study if it had clinical implications. Doppler detection was feasible in all cases and there were no false positive diagnoses. Comparison of haemodynamic data in patients without (group A) and with (group B) diastolic mitral regurgitation showed a significant increase in the mean values of pressures, particularly for the mean pulmonary artery and capillary wedge pressures (P less than 0.01 to 0.001), in group B. This study suggests that the recording of mitral flow velocity should be routinely performed in patients with such pathological conditions, since the finding of diastolic mitral regurgitation may have clinical significance.

Angiocardiography↗
PubMed1987

A new non-invasive estimation of the stenotic aortic valve area by pulsed Doppler mapping.

A new pulsed Doppler mapping technique has been used to measure the severity of aortic valve stenosis. The Doppler examination was performed at the site of the aortic orifice in the parasternal short axis echocardiographic view and the method was based on the detection of the area of systolic flow through the stenotic orifice. This area was derived by planimetry and the measurements obtained by the Doppler method were compared with the aortic valve area calculated at catheterisation according to the Gorlin formula. The method was applicable in 41 of the 44 patients studied. The Doppler data were consistent with the haemodynamic measurements even in patients with decreased cardiac index. It is concluded that this new application of the flow mapping procedure is reliable and is easily applied to adult patients with a wide range of clinical conditions.

Aortic Valve↗
PubMed1987

[Clinical value of the detection of diastolic mitral regurgitation by pulsed Doppler].

The reliability of pulsed Doppler echocardiography for the detection of mitral diastolic regurgitation was evaluated in 21 patients with severe aortic insufficiency and/or cardiomyopathy. Among these patients, 17 had sinus rhythm with a normal PR interval, while 4 had atrial fibrillation with short or normally lasting diastoles. Detection was negative in 10 cases (group A) and positive in the remaining 11 cases (group B). In all patients the data supplied by Doppler echocardiography were confirmed by angiography (100% sensitivity and specificity). A comparative study of right heart and left heart pressures in the two groups showed that group B patients had a special pressure profile, the most significant feature of which was an increase in pulmonary arterial and capillary pressures (p less than 0.01 and p less than 0.001 respectively). The diagnostic reliability of mitral valve diastolic regurgitation as to the presence of an abnormal mean pulmonary pressure was: sensitivity 80%, specificity 73%. Right heart pressures were either normal or very slightly elevated in group A patients. It is concluded that the presence of mitral diastolic regurgitation in patients with the pathology described indicates an unfavourable prognosis. This should be taken into account and lead to a systematic of mitral flow in these patients.

Aortic Valve Insufficiency↗
PubMed1986

[Doppler technics in the study of prosthetic valves].

The authors studied a group of 120 patients and a total of 137 valvular prostheses by ultrasonic pulsed Doppler (3 MHz). Fifty three of these prostheses were also investigated with continuous wave Doppler. Clinical, phonocardiographic and echocardiographic examination revealed 99 normal and 38 abnormal prostheses, the latter group comprising 42 dysfunctions (9 obstructions and 33 regurgitations), all confirmed by invasive studies. The lesions were graded into 3 degrees of severity. The methods used were the recording of velocity signals and two- and three-dimensional mapping in the pulsed Doppler mode, and the calculation of the haemodynamic parameters derived from measurements of blood velocity in the continuous wave mode. Pulsed Doppler correctly diagnosed 92 out of the 99 normal prostheses. The maximum systolic pressure gradient in aortic valve prostheses was 16 +/- 6 mmHg; the average early diastolic pressure gradient of the mitral valve prostheses was 10.01 +/- 3.34 mmHg, with a mean diastolic gradient of 4.52 +/- 0.71 mmHg and a mean pressure half time of 0.09 +/- 0.02 sec giving an average valve surface area of 2.45 +/- 0.57 cm2. The sensitivity and specificity of the diagnosis of valve dysfunction were 95 and 92 per cent respectively with a satisfactory evaluation of the degree of severity in 88 per cent of cases. In the 3 mitral valve prostheses with obstruction, significant abnormalities of pressure half time and value surface area were detected.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

Valvar prosthetic dysfunction. Localisation and evaluation of the dysfunction using the Doppler technique.

Thirty patients with 33 mitral or aortic prostheses or both were examined using the pulsed Doppler technique combined with cross sectional echocardiography to study the applicability of the Doppler technique in the diagnosis and evaluation of the severity of prosthetic dysfunction and to assess the ability of the mapping procedure to estimate the site and the size of the prosthetic defect. The dysfunction was valvar regurgitation in 29 instances and stenoses in eight, all of which were confirmed by invasive procedures. The severity of the dysfunction was graded on a three point scale. A control group of 73 subjects with 88 normal prostheses also underwent pulsed Doppler and cross sectional echocardiography. The pulsed Doppler study followed the usual procedure for a valvar disease including two and three dimensional mapping for regurgitation. Eight patients also underwent a continuous wave Doppler examination. The diagnostic reliability of the pulsed Doppler technique was greater than or equal to 90%. The severity of the dysfunction was accurately assessed in 86% of cases. In the case of aortic regurgitation, mapping of the jets was performed as easily for prostheses as for native regurgitant valves. In the case of mitral regurgitation, the mapping patterns depended on the cause of the dysfunction. With valvar tears, a jet was detected at the centre of the annulus, and with paravalvar leaks eccentric atrial jets were seen opposite the site of the leak. The pulsed Doppler and the surgical findings correlated well for both the site of the dysfunction (16/20 (80%) patients) and the size of the leak (13/16 (81%) patients). Thus, despite some limitations, pulsed Doppler and particularly the mapping procedure provide sufficient information to give an accurate non-invasive assessment of prosthetic valve dysfunction.

Aortic Valve↗