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Læknablaðið - 15.11.1988, Page 44

Læknablaðið - 15.11.1988, Page 44
384 LÆKNABLAÐIÐ túlka gætilega hjá sérhverjum sjúklingi vegna mikils breytileika í ósæðarlokuflæði (21). Frekari þróun Doppler aðferðarinnar mun væntanlega gera kleift að ákvarða hið eiginlega ósæðarlokuflatarmál óblóðugt (5, 17, 19). SUMMARY Continuous-wave Doppler echocardiography was performed in 30 consequtive adult patients (18 maies) with suspected aortic stenosis (AS) within 48 hours prior to cardiac catheterisation. The mean age was 63 ± 10 years (range 33-75 years); 28 (93%) of the patients were >50 years. The maximal Doppler and catheterisation gradients were similar and correlated closely (r = 0.96). Both these maximal gradients were different from, and significantly higher than the traditional peak-to-peak gradients at cátheterisation (p< 0.001). The mean Doppler and catheterisation gradients showed a close correlation (r = 0.93), but the mean Doppler gradients were on the average slightly lower than the mean catheterisation gradients (Y = 1.03X-6.1, p<0.001). A curvilinear regression function described the relationship of both the maximal and the mean Doppler gradients to the aortic valve area (AVA) indexes (cmVm1) at catheterisation (r = 0.80 and r = 0.78, respectively). Thus, significant AS, defined as an AVA index of <0.5 cmVm1, was usually represented by maximal and mean Doppler gradients of >54 and >33 mmHg, respectively. However, a considerable range of Doppler gradients corresponded to a given AVA index, illustrating the importance of also considering the influence of transvalvular aortic flow, when assessing the severity of AS. HEIMILDIR 1. Hatle L, Angelsen B, Tromsdal A. Noninvasive assessment of aortic stenosis by Doppler ultrasound. Br Heart J 1980; 43: 284-92. 2. Stamm RB, Martin RP. Quantification of pressure gradients across stenotic valves by Doppler ultrasound. JACC 1983; 2: 707-18. 3. Berger M, Berdoff RL, Gallerstein PE, Goldberg E. Evaluation of aortic stenosis by continuous wave Doppler ultrasound. JACC 1984; 3: 150-6. 4. Warth DC, Stewart WJ, Block PC, Weyman AE. A new method to calculate aortic valve areas without left heart catheterization. Circulation 1984; 70: 978-83. 5. Kosturakis D, Allen HD, Goldberg SJ, Sahn DJ, Valdes-Cruz LM. Noninvasive quantification of stenotic semilunar valve areas by Doppler echocardiography. JACC 1984; 3: 1256-62. 6. Simpson IA, Houston AB, Sheldon CD, Hutton I, Lawrie TDV. Clinical value of Doppler echocardiography in the assessment of adults with aortic stenosis. Br Heart J 1985; 53: 636-9. 7. Teien D, Erikson P. Quantification of transvalvular pressure differences in aortic stenosis by Doppler ultrasound. Int J Cardiol 1985; 7: 121-6. 8. Krafchek J, Robertson JH, Radford M, Adams D, Kisslo J. A reconsideration of Doppler assessed gradients in suspected aortic stenosis. Am Heart J 1985; 110: 765-73. 9. Agatson AS, Chengot M, Rao A, Hildner F, Samet P. Doppler diagnosis of valvular aortic stenosis in patients over 60 years of age. Am J Cardiol 1985; 56: 106-9. 10. Currie PJ, Seward JB, Reeder GS, et al. Continuous-wave Doppler echocardiographic assessment of severity of calcific aortic stenosis: a simultaneous Doppler-catheter correlative study in 100 adult patients. Circulation 1985; 71: 1162-9. 11. Hegranæs L, Hatle L. Aortic stenosis in adults. Non-invasive estimation of pressure difference by continuous wave Doppler echocardiography. Br Heart J 1985; 54: 396-404. 12. Yeager M, Yock PG, Popp RL. Comparison of Doppler-derived pressure gradients to that determined at cardiac catheterization in adults with aortic valve stenosis: implications and management. Am J Cardiol 1986; 57: 644-8. 13. Hatle L. Assessment of aortic stenosis with Doppler ultrasound (Editorial note). Int J Cardiol 1985; 127-8. 14. Gorlin R, Gorlin SG. Hydrolic formula for calculation of the area of the stenotic mitral valve, other cardiac valves, and central circulatory shunts. I. Am Heart J 1951; 41: 1-29. 15. Zar JH. Biostatistical analysis. Englewood Cliffs, NJ, Prentice. Hall, 1974. 16. Lewis JF, Kuo LC, Nelson JG, Limacher MC, Quinones MA. Pulsed Doppler echocardiographic determination of stroke volume and cardiac output: clinical validation of two new methods using the apical window. Circulation 1984; 70: 425-31. 17. Zhang Y, NitterHauge S, Ihlen H, Myhre E. Doppler echo-cardiographic measurements of cardiac output using the mitral orfice method. Br Heart J 1985; 53: 130-6. 18. Tortoledeo FA, Quinones MA, Fernandez GC, Waggoner AD, Winters WL. Quantification of left ventricular volumes by two-dimensional echocardiography: a simplified and accurate approach. Circulation 1983; 67: 579-84. 19. Skjærpe T, Hegranæs L, Hatle L. Noninvasive estimation of valve area in patients with aortic stenosis by Doppler ultrasound and two-dimensional echocardiography. Circulation 1985; 72: 810-18. 20. Hatle L, Angelsen B. Doppler ultrasound in cardiology. Philadelphia, Lea & Febiger, 1985. 21. Danielsen R, Nordrehaug JE, Stangeland L, Vik-Mo H. Limitations in assessing the severity of aortic stenosis by Doppler gradients. Br Heart J 1988; 59: 551-5.

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