Biomedical subjects

D Sainte Beuve

Publications and source records attributed to D Sainte Beuve.

10 recordsLinked to original sources

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↗

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↗

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↗

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

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↗

PubMedDate not supplied

Respective timing of maximal color Doppler jet areas and of peak velocity of jets in left-sided valvular lesions: clinical implications.

Time intervals between the R wave of the electrocardiogram and maximal dimension of jet areas of color Doppler and the R wave of the electrocardiogram and peak velocity of valvular jets of continuous-wave Doppler were compared by use of paired and correlative studies for a group of 55 patients with a total of 71 left-sided lesions. Mean values of both time intervals, mean difference, and its standard error were equal to zero for stenoses. Time intervals of 71% for mitral stenosis and 52% for aortic stenosis did not differ by more than 0.01 second; correlation coefficients were 0.96 for mitral stenosis and 0.85 for aortic stenosis. For regurgitations, differences in mean values and a mean difference with a standard error were found but remained unsignificant. However, the percentage of differences in time intervals below or equal to 0.01 second decreased to 35 for aortic regurgitation and 13 for mitral regurgitation, which showed the widest 95% range of differences. Correlation coefficients were 0.84 for the aortic regurgitation and 0.33 for mitral regurgitation. Thus the close relationship of time intervals suggests that standardized timing of area measurements at peak velocity is feasible for stenoses and remains under consideration for aortic regurgitation. Timing of measurements should remain empiric for mitral regurgitation.

Adolescent↗