ABSTRACT
Cardiovascular MR/CT Center and Heart Center of Indiana, The Care Group, LLC, Indianapolis, Indiana, U.S.A.
INTRODUCTION
Diagnostic imaging is an important component of the management of the patients with valvular heart disease. Echocardiography and cardiac catherization are the methods traditionally used to evaluate valvular disease. Echocardiography allows quantitative techniques to assess stenotic valves by calculating transvalvular pressure gradient and valve areas from the increase in blood flow velocity caused by the stenotic orifice. Cardiac catherization allows direct measurement of pressures in the heart, as well as the connected vessels and thus continues to be the gold standard for accurate measurement of pressure gradients and valve areas in this patient population. Echocardiographic evaluation of valvular regurgitation is semiquantitative and relies more on the subjective visual assessment of the regurgitant jet with the use of color flow mapping. Color flow Doppler
images are more reflective of the velocity of flow rather than the volume of regurgitant jets. Cardiac catherization grading of regurgitant lesions is imprecise and depends on many factors such as catheter position, the amount and rate of injected contrast media, chamber size, etc. These cause significant overlap in a grading of valvular regurgitations. Also, X-ray angiographic methods to calculate regurgitant volumes involving angiographic, thermodilution, and Fick methods involve complex methodology and are less reliable at low or high cardiac outputs. Also, angiography, due to its invasive nature, is not suitable for long-term follow-up of these patients.
