Left ventricular flow patterns in healthy subjects and patients with prosthetic mitral valves: An in vivo study using echocardiographic particle image velocimetry

Faludi, Réka; Szulik, Mariola; D'hooge, Jan; Herijgers, Paul; Rademakers, Frank; Pedrizzetti, Gianni; Voigt, Jens-Uwe

doi:10.1016/j.jtcvs.2009.07.060

« Previous Next »The Journal of Thoracic and Cardiovascular Surgery
Volume 139, Issue 6 , Pages 1501-1510, June 2010

Left ventricular flow patterns in healthy subjects and patients with prosthetic mitral valves: An in vivo study using echocardiographic particle image velocimetry

Réka Faludi, MD
- Department of Cardiology, University Hospital Gasthuisberg, Catholic University Leuven, Leuven, Belgium
Mariola Szulik, MD
- Department of Cardiology, University Hospital Gasthuisberg, Catholic University Leuven, Leuven, Belgium
Jan D'hooge, PhD
- Department of Cardiology, University Hospital Gasthuisberg, Catholic University Leuven, Leuven, Belgium
Paul Herijgers, MD, PhD
- Department of Cardiac Surgery, University Hospital Gasthuisberg, Catholic University Leuven, Leuven, Belgium
Frank Rademakers, MD, PhD
- Department of Cardiology, University Hospital Gasthuisberg, Catholic University Leuven, Leuven, Belgium
Gianni Pedrizzetti, PhD
- Department of Civil Engineering, University of Trieste, Trieste, Italy
Jens-Uwe Voigt, MD, PhD
- Department of Cardiology, University Hospital Gasthuisberg, Catholic University Leuven, Leuven, Belgium
- Address for reprints: Jens-Uwe Voigt, MD, PhD, Department of Cardiology, University Hospital Gasthuisberg Cath. University Leuven, Herestraat 49, 3000 Leuven, Belgium.

Received 5 December 2008; received in revised form 10 June 2009; accepted 6 July 2009. published online 05 April 2010.

Objective

Echocardiographic particle image velocimetry is a new feature tracking–based approach to visualize and quantify left ventricular flow patterns in vivo. We investigated the potential role of this new technique by assessing vortex formations in healthy left ventricles and the effect of different types of prosthetic valves on intraventricular flow patterns and flow-mediated energy dissipation.

Methods

We examined 19 patients (mean age, 57 ± 19 years; 10 women). Nine were healthy, and 10 had prosthetic mitral valves (5 had bileaflet valves, 4 had bioprostheses, and 1 had a tilting-disc valve). Boluses of left heart contrast were administered intravenously. Echocardiographic apical views were analyzed offline by using prototype software that allowed intracavitary flow to be explored and enabled calculations of energy dissipation (relative pulsatile vorticity strength and vortex pulsation correlation) by means of particle image velocimetry.

Results

In healthy hearts a vortex filling the entire ventricle stores the kinetic energy of the blood and smoothly redirects the blood to the outflow tract. In patients with prosthetic valves, completely different flow patterns were identified depending on the type, orientation, and position of the valves, as well as left ventricular geometry. Patients with prosthetic valves showed significantly higher left ventricular energy dissipation than healthy subjects (relative pulsatile vorticity strength, 2.4 ± 0.7 vs 1.6 ± 0.4 [P < .001]; vortex pulsation correlation, 1.2 ± 0.5 vs 0.7 ± 0.2 [P < .001]).

Conclusions

Echocardiographic particle image velocimetry is feasible. It clearly distinguishes flow patterns in healthy hearts from those in hearts with different types of prosthetic valves. Echocardiographic particle image velocimetry offers new insights into cardiac function and might be of importance to optimize valve replacement therapy.

CTSNet classification: 17, 18, 22

Abbreviations and Acronyms: MRI, magnetic resonance imaging, PIV, particle image velocimetry, RS, relative pulsatile vorticity strength, VPC, vortex pulsation correlation, VRS, vortex relative pulsatile vorticity strength