4-DIMENSIONAL IS BETTER THAN 3-DIMENSIONAL DOPPLER GRADING OF MITRAL REGURGITANT JETS WITH TEMPORAL VARIATIONS

Temporal variations of mitral regurgitant jet areas are never taken in to account in the color Doppler grading of the regurgitation which rel ies on measurements of maximal areas alone, with variable success rate . The purpose was to study if the grading would be improved by averagi ng measurements of jet areas according to their temporal variations. D oppler grading relied on three-dimensional measurements of length and height of jet areas in the long axis and of their width in the short a xis views, with calculation of the total regurgitant index. It was com pared with angiographic grading in 40 patients with mitral regurgitati on. Maximal areas were retained to calculate the maximal index when on ly less than 10% variation occurred throughout systole. In case of tem poral variations, the index was weighted by averaging the measurements over early, mid and end systole. No temporal variation was noted in 2 6 patients (65%) who all but 3 were satisfactorily graded by the maxim al index. In 14 patients (35%), temporal variations required calculati on of the weighted index: it modified the grading for 11 patients (78. 5%) all of mild and moderate grades overestimated by the maximal index , with success in 10 (90.9%), increasing the correlation coefficient b etween angiographic and Doppler grading from 0.79 (maximal) to 0.93 (w eighted). Grading from maximal areas is convenient for severe and for most cases of regurgitation without temporal variations. Errors interv ene for mild and moderate grades in case of temporal variations, and m ay be avoided by combining fourth temporal with spatial three-dimensio nal Doppler data.