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You are here: Contents > 2002 > Volume 11 Number 4 July 2002 > HEMODYNAMICS AND ECHOCARDIOGRAPHY > In-Vivo Analysis of the Instantaneous Transvalvular Pressure Difference-Flow Relationship in Aortic Valve Stenosis: Implications of Unsteady Fluid-Dynamics for the Clinical Assessment of Disease Severity

In-Vivo Analysis of the Instantaneous Transvalvular Pressure Difference-Flow Relationship in Aortic Valve Stenosis: Implications of Unsteady Fluid-Dynamics for the Clinical Assessment of Disease Severity

Javier Bermejo MD, J. Carlos Antoranz PhD, Ian G. Burwash MD, Jose L. Rojo Alvarez PhD, Mar Moreno MD, Miguel A. García-Fernández MD, Catherine M. Otto MD

In order to validate in-vivo valve area as a measurement of the severity of aortic stenosis (AS), chronic valvular obstruction was created surgically in 11 dogs. Transvalvular pressure drop and flow rate were recorded using high-fidelity micromanometers and transit-time probes under changing hemodynamic conditions. An adapted form of the unsteady Bernoulli equation accurately fitted measured hemodynamics and provided an estimate of valve area from instantaneous paired

pressure and flow data. In addition, inverse transaortic pressure gradients were observed during late-ejection, and caused the ejection period to be systematically underestimated when determined from the crossover of left ventricular and aortic pressures. Thus, fluid-dynamic analysis demonstrates that valve area best characterizes AS in vivo. However, when measured invasively, reverse pressure gradients introduce a non-reported source of error in the Gorlin method.

In-Vivo Analysis of the Instantaneous Transvalvular Pressure Difference-Flow Relationship in Aortic Valve Stenosis: Implications of Unsteady Fluid-Dynamics for the Clinical Assessment of Disease Severity

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