PROXIMAL JET SIZE BY DOPPLER COLOR-FLOW MAPPING PREDICTS SEVERITY OF MITRAL REGURGITATION - CLINICAL-STUDIES

Background Recent studies have shown that many instrument and physiolo gical factors limit the ability of color Doppler total jet area within the receiving chamber to predict the severity of valvular regurgitati on. In contrast, the proximal or initial dimensions of the jet as it e merges from the orifice have been shown to increase directly with orif ice size and to correlate well with the severity of aortic insufficien cy. Only limited data, however, are available regarding the value of p roximal jet size in mitral regurgitation, and it has not been examined in short-axis or transthoracic views. The purpose of the present stud y, therefore, was to evaluate the relation between proximal jet size a nd other measures of the severity of mitral regurgitation. Methods and Results In 49 patients, the anteroposterior height of the proximal je t as it emerges from the mitral valve was measured in the parasternal long-axis view; proximal jet width and area were measured in the short -axis view at the same level. Results were compared with regurgitant v olume and fraction by pulsed Doppler subtraction of aortic and mitral flows in 47 patients without more than trace aortic insufficiency; wit h angiographic grade determined within 24 hours in 33 catheterized pat ients; and with angiographic regurgitant fraction in 13 patients who w ere in normal sinus rhythm and had no significant aortic and tricuspid insufficiency. Proximal jet height, width, and area correlated well w ith Doppler regurgitant volume and fraction (r=.86 to .95; SEE=7.7 to 9.0 mL; 5.9% to 7.3%). Proximal jet size could also be used to disting uish angiographic grades of mitral regurgitation with minimal overlap (P<.0001) and correlated well with angiographic regurgitant fraction ( r=.85 to .91; SEE=4.1% to 5.1%). Conclusions Proximal jet size correla tes well with established measures of the severity of, mitral regurgit ation. It is conveniently available with transthoracic clinical scanni ng and should be useful in the routine evaluation of patients with mit ral regurgitation.