Novel method of measuring valvular regurgitation using three-dimensional nonlinear curve fitting of Doppler signals within the flow convergence zone.

Abstract

Mitral valve regurgitation (MR) is among the most prevalent and significant valve problems in the Western world. Echocardiography plays a significant role in the diagnosis of degenerative valve disease. However, a simple and accurate means of quantifying MR has eluded both the technical and clinical ultrasound communities. Perhaps the best clinically accepted method used today is the 2-D proximal isovelocity surface area (PISA) method. In this study, a new quantification method using 3-D color Doppler ultrasound, called the field optimization method (FOM), is described. For each 3-D color flow volume, this method iterates on a simple fluid dynamics model that, when processed by a model of ultrasound physics, attempts to agree with the observed velocities in a least-squares sense. The output of this model is an estimate of the regurgitant flow and the location of its associated orifice. To validate the new method, in vitro experiments were performed using a pulsatile flow loop and different geometric orifices. Measurements from the FOM and from 2-D PISA were compared with measurements made with a calibrated ultrasonic flow probe. Results show that the new method has a higher correlation to the truth data and has lower inter- and intra-observer variability than the 2-D PISA method.