Investigating the shortcomings of the Flow Convergence Method for quantification of mitral regurgitation in a pulsatile in-vitro environment and with Computational Fluid Dynamics
arxiv(2024)
摘要
The flow convergence method includes calculation of the proximal isovelocity
surface area (PISA) and is widely used to classify mitral regurgitation (MR)
with echocardiography. It constitutes a primary decision factor for
determination of treatment and should therefore be a robust quantification
method. However, it is known for its tendency to underestimate MR and its
dependence on user expertise. The present work systematically compares
different pulsatile flow profiles arising from different regurgitation orifices
using transesophageal chocardiographic probe and particle image velocimetry
(PIV) as a reference in an in-vitro environment. It has been found that the
inter-observer variability using echocardiography is small compared to the
systematic underestimation of the regurgitation volume for large orifice areas
(up to 52
occurs. From a flow perspective, a starting vortex was found as a dominant flow
pattern in the regurgant jet for all orifice shapes and sizes. A series of
simplified computational fluid dynamics (CFD) simulations indicate that
selecting a suboptimal aliasing velocity during echocardiography measurements
might be a primary source of potential underestimation in MR characterization
via the PISA-based method, reaching up to 40
observations that physicians often select an aliasing velocity higher than
necessary for optimal estimation in diagnostic procedures.
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