Skip Navigation

European Heart Journal 1999 20(18):1355-1363; doi:10.1053/euhj.1998.1479
Copyright © 1999 by the European Society of Cardiology.
This Article
Right arrow Abstract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow E-letters: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when E-letters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Search for citing articles in:
ISI Web of Science (15)
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Schöbel, W.A.
Right arrow Articles by Karsch, K.-R.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Schöbel, W.A.
Right arrow Articles by Karsch, K.-R.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

Extent, determinants and clinical importance of pressure recovery in patients with aortic valve stenosis

W.A. Schöbela,f1, W. Voelkerb, K.K. Haasec and K.-R. Karscha

a Department of Cardiology, University of Tübingen, Tübingen, Germany
b Department of Cardiology, Klinikum Mannheim, University of Heidelberg, Mannheim, Germany
c Department of Cardiology, Klinikum Ludwigshafen, Ludwigshafen, Germany

revised December 14, 1998; accepted December 16, 1998

Abstract

Aims In experimental studies the recovery of pressure distal to stenotic valve orifices has been well described. We evaluated the extent, determinants, and clinical importance of pressure recovery in patients with aortic valve stenosis.

Methods and Results The study was performed in 37 patients with aortic valve stenosis, in whom cardiac catheterization was performed and left ventricular and aortic pressures were determined using a high-fidelity multi-tip micromanometer catheter. To register the pressure waveforms accurately the catheter was positioned so that the proximal micromanometer was in the left ventricle, the second at the site of minimal pressure in the vena contracta, and the third (the most distal) in the ascending aorta 16cm further downstream. The amount of pressure recovery within the ascending aorta was up to 44% of the maximal pressure drop. The index pressure recovery was directly correlated to the Gorlin-derived aortic valve area (r=0·80) and indirectly correlated to the ratio of aortic valve area and the cross-sectional area of the ascending aorta.

Conclusions This clinical study confirmed experimental data, that index pressure recovery is dependent on the ratio of the effective valve area and the cross-sectional area of the ascending aorta. Pressure recovery may need to be considered in patients with mild to moderate aortic stenosis and with a small cross-sectional area of the ascending aorta.

Key Words: Aortic valve stenosis, multi-tip micromanometer catheter, pressure recovery

f1 Correspondence : Dr Wolfgang A. Schöbel, Department of Cardiology, University of Tübingen, Otfried-Müller Straße 10, 72076 Tübingen, Germany.

References

  1. Baumgartner H, Schima H, Tulzler G, Kühn P. Effect of stenosis geometry on the Doppler-Catheter gradient relation in vitro: A manifestation of pressure recovery. J Am Coll Cardiol. 1993;21:1018–1025[Abstract]
  2. Levine RA, Jimoh A, Cape EG, McMillan S, Yoganathan AP, Weyman AE. Pressure recovery distal to a stenosis: potential cause of gradient ‘overestimation’ by Doppler echocardiogaphy. J Am Coll Cardiol. 1989;13:706–715[Abstract]
  3. Niederberger J, Schima H, Maurer G, Baumgartner H. Importance of pressure recovery for the assessment of aortic stenosis by Doppler ultrasound. Role of aortic size, aortic valve area, and direction of the stenotic jet in vitro. Circulation. 1996;94:1934–1940[Abstract/Free Full Text]
  4. Stewart SFC, Nast EP, Arabia FA, Talbot TL, Proschan M, Clark RE. Errors in pressure gradient measurements by continuous wave Doppler ultrasound: Type, size and age effects in bioprosthetic aortic valves. J Am Coll Cardiol. 1991;18:769–779[Abstract]
  5. Voelker W, Reul H, Stelzer T, Schmidt A, Karsch KR. Pressure recovery in aortic stenosis: an in vitro study in a pulsatile flow model. J Am Coll Cardiol. 1992;20:1585–1593[Abstract]
  6. Yoganathan AP, Cape EG, Sung HW, Willams FP, Jimoh A. Review of hydrodynamic principles for the cardiologist: Applications to the study of blood flow and jets by imaging techniques. J Am Coll Cardiol. 1988;12:1344–1353[Abstract]
  7. Pasipoularides A. Clinical assessment of ventricular ejection dynamics with and without outflow obstruction. J Am Coll Cardiol. 1990;15:859–882[Abstract]
  8. Cape EG, Jones M, Yamada I, VanAuker MD, Valdes Cruz LM. Turbulent/viscous interactions control Doppler/catheter pressure discrepancies in aortic stenosis. The role of the Reynolds number. Circulation. 1996;94:2975–2981[Abstract/Free Full Text]
  9. Laskey WK, Kussmaul WG. Pressure recovery in aortic valve stenosis. Circulation. 1994;89:116–121[Abstract/Free Full Text]
  10. Clark C. The fluid mechanics of aortic stenosis—II. Unsteady flow experiments. J Biomechanics. 1976;9:567–573[CrossRef][Web of Science][Medline]
  11. Gorlin R, Gorlin SG. Hydraulic formula for calculation of the area of the stenotic mitral valve, other cardiac valves, and central circulatory shunts. Am Heart J. 1951;41:1–29[CrossRef][Web of Science][Medline]
  12. Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986;1:307–310[CrossRef][Web of Science][Medline]
  13. Holen J, Waag RC, Gramiak R. Doppler ultrasound in aortic stenosis: In vitro studies of pressure gradient determination. Ultrasound Med Biol. 1987;13:321–328[CrossRef][Web of Science][Medline]
  14. Chambers J. Is pressure recovery an important cause of ‘Doppler aortic stenosis’ with no gradient at cardiac catheterisation? [editorial]. Heart. 1996;76:381–383[Free Full Text]
  15. Levine RA, Cape EG, Yoganathan AP. Pressure recovery distal to stenoses: expanding clinical applications of engineering principles. J Am Coll Cardiol. 1993;21:1026–1028[Web of Science][Medline]
  16. Zoghbi WA, Farmer KL, Soto JG, Nelson JG, Quinones MA. Accurate noninvasive quantification of stenotic aortic valve area by Doppler echocardiography. Circulation. 1986;73:452–459[Abstract/Free Full Text]
  17. Blitz LR, Herrmann HC. Hemodynamic assessment of patients with low-flow, low-gradient valvular aortic stenosis. Am J Cardiol. 1996;78:657–661[CrossRef][Web of Science][Medline]
  18. Burwash IG, Thomas DD, Sadajhir M. Dependence of Gorlin formula and continuity equation valve areas on transvalvular volume flow rate in valvular aortic stenosis. Circulation. 1994;89:827–835[Abstract/Free Full Text]
  19. Casale PN, Palacios IF, Abascal VM. Effects of dobutamine on Gorlin and continuity equation valve areas and valve resistance in valvular aortic stenosis. Am J Cardiol. 1992;70:1175–1179[CrossRef][Web of Science][Medline]
  20. Adele C, Vaitkus PT, Tischler MD. Evaluation of the significance of a transvalvular catheter on aortic valve gradient in Aortic stenosis: a direct hemodynamic and doppler echocardiographic study. Am J Cardiol. 1997;79:513–516[CrossRef][Web of Science][Medline]
  21. Sung HW, Yu PS. Does the catheter tip position in cardiac catheterization affect assessment of aortic valve stenosis: an in vitro study. J Chinese Inst Chem Engineers. 1996;27:163–171
  22. Carabello BA, Barry WH, Grossmann W. Changes in arterial pressure during left heart pullback in patients with aortic stenosis: a sign of severe aortic stenosis. Am J Cardiol. 1979;44:424–427[CrossRef][Web of Science][Medline]
  23. Tindale WB, Trowbridge EA. Modification of the Gorlin equation for use with heart valve substitutes. Cardiovasc Res. 1986;20:458–465[Web of Science][Medline]
  24. Heinrich RS, Fontaine AA, Grimes RY. Experimental analysis of fluid mechanical energy losses in aortic valve stenosis: importance of pressure recovery. Ann Biomed Eng. 1996;24:685–694[Web of Science][Medline]
  25. Sabbah HN, Stein PD. Reduction of systolic coronary blood flow in experimental left ventricular outflow tract obstruction. Am Heart J. 1988;116:806–811[CrossRef][Web of Science][Medline]
  26. Flachskampf FA, Weyman AE, Guerrero JL, Thomas JD. Influence of orifice geometry and flow rate on effective valve area: An in vitro study. J Am Coll Cardiol. 1990;15:1173–1180[Abstract]

Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?


This article has been cited by other articles:


Home page
 Anesth. Analg.Home page
D. Oxorn
The Intraoperative Quantification of Aortic Stenosis
Anesth. Analg., January 1, 2009; 108(1): 10 - 12.
[Full Text] [PDF]

Home page
 HeartHome page
L Kadem, J G Dumesnil, R Rieu, L-G Durand, D Garcia, and P Pibarot
Impact of systemic hypertension on the assessment of aortic stenosis
Heart, March 1, 2005; 91(3): 354 - 361.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Physiol. Heart Circ. Physiol.Home page
K. E. Richards, D. Deserranno, E. Donal, N. L. Greenberg, J. D. Thomas, and M. J. Garcia
Influence of structural geometry on the severity of bicuspid aortic stenosis
Am J Physiol Heart Circ Physiol, September 1, 2004; 287(3): H1410 - H1416.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
D. Garcia, J. G. Dumesnil, L.-G. Durand, L. Kadem, and P. Pibarot
Discrepancies between catheter and Doppler estimates of valve effective orifice area can be predicted from the pressure recovery phenomenon: practical implications with regard to quantification of aortic stenosis severity
J. Am. Coll. Cardiol., February 5, 2003; 41(3): 435 - 442.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
R. A. Levine and E. Schwammenthal
Stenosis is in the eye of the observer: impact of pressure recovery on assessing aortic valve area
J. Am. Coll. Cardiol., February 5, 2003; 41(3): 443 - 445.
[Full Text] [PDF]

Home page
 Eur Heart JHome page
K. Isaaz
The ratio of post-valvular aorta to valvular orifice cross-sectional areas: a new haemodynamic index of clinical importance in patients with aortic stenosis?
Eur. Heart J., September 2, 1999; 20(18): 1294 - 1296.
[PDF]

This Article
Right arrow Abstract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow E-letters: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when E-letters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Search for citing articles in:
ISI Web of Science (15)
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Schöbel, W.A.
Right arrow Articles by Karsch, K.-R.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Schöbel, W.A.
Right arrow Articles by Karsch, K.-R.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?