COLOR 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 subv alvar flow broadening in deciding the type of mitral stenosis surgery. Patients-30 patients, mean age 47 years, with severe stenosis undergo ing 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 refe rence, representing mild stenosis without subvalvar connection. Method s-For echo, the score proposed by Wilkins for cross sectional imaging was used. For Doppler, the flow diameters were measured in cm by an in dependent examiner from the long axis view in early diastole at two le vels: (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 valu e was compared for both procedures. Results-There was no significant d ifference in age, mitral valve areas, or haemodynamics for the two gro ups. 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 fo r an open heart commissurotomy of respective cut off points was: Doppl er 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 ap pears to better reflect the subvalvar involvement and changes in kinet ics than the echo score alone. This easy Doppler method might become a routine examination for follow up of patients with open heart commiss urotomy, to avoid performing repeated transoesophageal echocardiograph y.