Doppler echocardiographic assessment of the valve area in patients with atrioventricular valve stenosis by application of the continuity equation

The orifice area was non-invasively assessed in 19 patients with mitral or mitral and tricuspid stenosis by combined cross-sectional and Doppler echocardiography. Stroke volume was calculated as the product of aortic or pulmonic cross-sectional area and the time velocity integral of the flow across that valve, and the stenotic valve area was obtained as the stroke volume divided by the time velocity integral of the stenotic valve. In addition, the mitral valve area was estimated by the pressure half-time method of Hatle et al. The non-invasive determinations were compared with those calculated by the Gorlin formula at cardiac catheterization. The valve area obtained by combined cross-sectional and Doppler echocardiography showed a close correlation with the Gorlin area, r = 0.90, SEE = 0.13 cm2, n = 20. In contrast, the valve area estimated by the pressure half-time method showed only a moderate correlation with the Gorlin area, r = 0.68, SEE = 0.38 cm2, n = 18, and estimates by this method tended to significantly overestimate the Gorlin area. In conclusion, non-invasive valve area determinations based on combined cross-sectional and Doppler echocardiography can be used to accurately quantify the severity of the lesion in patients with atrioventricular valve stenosis, while determinations by the pressure half-time method may show errors of a magnitude that limits its clinical applicability.