Joakim Brandberg

Aortic prosthetic valve design and size: relation to Doppler echocardiographic findings and pressure recovery- an in vitro study.

The extent to which Doppler echocardiography information can be used in the assessment of prosthesis hemodynamic performance is still controversial. The goals of our study were to assess the importance of valve design and size both on Doppler echocardiography findings and on pressure recovery in a fluid mechanics model. We performed Doppler and catheter measurements in the different orifices of the bileaflet St Jude (central and side orifices), the monoleaflet Omnicarbon (major and minor orifices), and the stented Biocor porcine prosthesis. Net pressure gradients were predicted from Doppler flow velocities, assuming either independence or dependence of valve size. The peak Doppler estimated gradients (mean +/- SD for sizes 21 to 27) were 21 +/- 10.3 mm Hg for St Jude, 18 +/- 9.3 mm Hg for Omnicarbon, and 37 +/- 14.5 mm Hg for Biocor (P <.05 for St Jude and Omnicarbon vs Biocor). The pressure recovery (proportion of peak catheter pressure) was 53% +/- 8.6% for central-St Jude, 29% +/- 8. 9% for side-St Jude, 20% +/- 5.6% for major-Omnicarbon, 23% +/- 7.4% for minor-Omnicarbon, and 18% +/- 3.6% for Biocor (P <.05 for central-St Jude and side-St Jude vs Omnicarbon and Biocor). Valve sizes (x) significantly influenced pressure recovery (y in percentage) (central-St Jude: y = 3.7x - 35.9, r = 0.88, P =.0001; major-Omnicarbon: y = 2.1x - 30.3, r = 0.85, P =.0001). By assuming dependence of valve size, Doppler was able to predict net pressure gradients in St Jude with a mean difference between net catheter and Doppler-predicted gradient of -3.8 +/- 2.5 mm Hg. In conclusion, prosthetic valve design and size influence the degree of pressure recovery, making Doppler gradients potentially misleading in both the assessment of hemodynamic performance and the comparison of one design with another. The preliminary results indicate that net gradient can be predicted from Doppler gradients.

Increased accuracy of echocardiographic measurement of flow using automated spherical integration of multiple plane velocity vectors

The calculation of blood flow in the heart by surface integration of velocity vectors (SIVV) using Doppler ultrasound is independent of the angle. Flow is normally calculated from velocity in a spherical thick shell with its center located at the ultrasound transducer. In a numerical simulation, we have shown that the ratio between minor and major axes of an elliptic flow area substantially influences the accuracy of the estimation of flow in a single scan plane. The accuracy of flow measurements by SIVV can be improved by calculating the mean of the values from more than one scan plane. We have produced an automated computer program that includes an antialiasing procedure. We confirmed an improvement of flow measurements in a pulsatile hydraulic flow model, the 95% confidence interval for single estimations being reduced from 20% to 10% (p < 0.05) using the newly developed software. We think that the SIVV method has important implications for clinical transthoracic echocardiography.

Pediatric cardiac output measurement using surface integration of velocity vectors an in vivo validation study

ObjectiveTo test the accuracy and reproducibility of systemic cardiac output (CO) measurements using surface integration of velocity vectors (SIVV) in a pediatric animal model with hemodynamic instability and to compare SIVV with traditional pulsed-wave Doppler measurements. DesignProspective, comparative study. SettingAnimal research laboratory at a university medical center. SubjectsEight piglets weighing 10–15 kg. InterventionsHemodynamic instability was induced by using inhalation of isoflurane and infusions of colloid and dobutamine. MeasurementsSIVV CO was measured at the left ventricular outflow tract, the aortic valve, and ascending aorta. Transit time CO was used as the reference standard. ResultsThere was good agreement between SIVV and transit time CO. At high frame rates, the mean difference ± 2 sd between the two methods was 0.01 ± 0.27 L/min for measurements at the left ventricular outflow tract, 0.08 ± 0.26 L/min for the ascending aorta, and 0.06 ± 0.25 L/min for the aortic valve. At low frame rates, measurements were 0.06 ± 0.25, 0.19 ± 0.32, and 0.14 ± 0.30 L/min for the left ventricular outflow tract, ascending aorta, and aortic valve, respectively. There were no differences between the three sites at high frame rates. Agreement between pulsed-wave Doppler and transit time CO was poorer, with a mean difference ± 2 sd of 0.09 ± 0.93 L/min. Repeated SIVV measurements taken at a period of relative hemodynamic stability differed by a mean difference ±2 sd of 0.01 ± 0.22 L/min, with a coefficient of variation = 7.6%. Intraobserver coefficients of variation were 5.7%, 4.9%, and 4.1% at the left ventricular outflow tract, ascending aorta, and aortic valve, respectively. Interobserver variability was also small, with a coefficient of variation = 8.5%. ConclusionsSIVV is an accurate and reproducible flow measurement technique. It is a considerable improvement over currently used methods and is applicable to pediatric critical care.

DOPPLER FLOW MEASUREMENT USING SURFACE INTEGRATION OF VELOCITY VECTORS (SIVV): IN VITRO VALIDATION

Blood flow measurement using an improved surface integration of velocity vectors (SIVV) technique was tested in in vitro phantoms. SIVV was compared with true flow (12-116 mL/s) in a steady-state model using two angles of insonation (45 degrees and 60 degrees ) and two vessel sizes (internal diameter = 11 and 19 mm). Repeatability of the method was tested at various flow rates for each angle of insonation and vessel. In a univentricular pulsatile model, SIVV flow measured at the mitral inlet was compared to true flow (29-61 mL/s). Correlation was excellent for the 19-mm vessel (r(2)= 0.99). There was a systematic bias but close limits of agreement (mean +/- 2 SD = -24.1% +/- 7.6% at 45 degrees; +16.4% +/- 11.0% at 60 degrees ). Using the 11-mm vessel, a quadratic relationship was demonstrated between between SIVV and true flow (r(2) = 0.98-0.99), regardless of the angle of insonation. In the pulsatile system, good agreement and correlation were shown (r(2) = 0.94, mean +/- 2 SD = -4.7 +/- 10.1%). The coefficients of variation for repeated SIVV measurements ranged from 0.9% to 10.3%. This method demonstrates precision and repeatability, and is potentially useful for clinical measurements.

3-D Flow Visualization for Construction of the Model of the Blood Flow in the Heart

The authors have been developing a model of blood flow in the heart. The flow model of the heart enables us to estimate the entire blood flow of the heart from a couple of 2-D color Doppler images. Therefore, the load on patients is expected to be reduced. To develop the model of the heart, precise observation and an understanding of the blood flow are indispensable, because the flow is strongly related to the diagnosis of heart diseases. The visualization method must have the following features: (1) 3-D (2) objectivity (3) interactivity and (4) multi-aspect. The authors have developed visualization methods to meet the above-mentioned requirements and evaluated the proposed methods with the in-vitro flow data set. The results clearly reveal that the proposed system enables the researchers of the modeling group to obtain the state of entire flow, such as the occurrence of turbulence.

Colour Doppler Flow Measurements Using Surface Integration of Velocity Vectors (SIVV): Effect of Colour Flow Gain, Pulse Repetition Frequency and Number of Imaging Planes

Colour Doppler flow measurements using surface integration of velocity vectors (SIVV) : Effect of colour flow gain, pulse repetition frequency and number of imaging planes

Computer simulation for improved assessment of mitral regurgitation

Since valvular regurgitation is one of the most common malfunctions of the heart the quantification of valvular regurgitation by means of non-invasive methods is desired. However existing methods for quantitative assessment is far from perfect. The aim of this paper is to study the proximal velocity field for non-stationary flow and non-planar geometries by computer simulation, which were performed using the FIDAP package to numerically solve the governing equations. A plexiglass in-vitro model similar to the computer model was used for comparison and the same results were obtained. The authors have found that it is possible to refine the PISA method and standardize flow calculations. Further improvements will hopefully create a tool for the echocardiographer that will facilitate evaluation and clinical applicability of the PISA approach.

In vivo estimation of cardiovascular flows with surface integration of velocity vectors from color Doppler imaging

Ultrasound can be used to noninvasively study the pumping heart. To be able to obtain more accurate flow estimates, we have designed the Surface Integration of Velocity Vectors (SIVV) echocardiographic method for angle independent determination of cardiac flow. The aim is to develop a noninvasive method for quantification of volume flows that can be used instead of the invasive methods that exist today. Using gated and time-delayed electrocardiographic acquisitions, Doppler data (Vingmed CFM 800) was collected for consecutive heart beats. Left ventricular inflow and outflow regions were studied. The SIVV analysis with velocity information from a variable number of planes as well as different wall filters and the time correction algorithm as described by Eidenvall et al. (1992), are implemented. Preliminary data from stroke volume determination agrees well (8% difference, 67 ml by SIVV versus 62 ml by the Fick equation).