Pulsed, continuous, and color flow Doppler echocardiographic assessment of normal and abnormal Ionescu-Shiley pericardial valves.
We studied the value of pulsed, continuous, and color flow Doppler echocardiography for identifying normal and abnormal function in 51 Ionescu-Shiley bovine pericardial valves. In 15 patients with clinically normal functioning mitral valves, the peak and mean pressure gradients as calculated by the modified Bernoulli equation were 8.5 +/- 4.9 mmHg (mean +/- SD) and 2.6 +/- 2.9 mmHg, respectively. The mitral valve area as calculated by the pressure half-time method was 2.2 +/- 0.6 cm2. In 18 patients with normally functioning aortic valves, the peak and mean pressure gradients were 22.9 +/- 9.0 mmHg and 11.1 +/- 5.0 mmHg, respectively. In five patients with suspected mitral prosthetic dysfunction, two-dimensional and Doppler echocardiography showed: two had mitral stenosis with a mean gradient of 14.2 mmHg and mean mitral valve area of 1.0 cm2, two had severe mitral regurgitation, and one was thickened but nonstenotic. In 13 patients with suspected aortic prosthetic dysfunction, two-dimensional and Doppler echocardiography showed: two patients had markedly thickened leaflets and mean aortic gradient of 41.5 mmHg, two patients had mild aortic regurgitation, four patients had severe aortic regurgitation, and five patients had systolic murmurs secondary to pathology unrelated to the prosthetic aortic valve. Of the three patients with severe aortic regurgitation who had color Doppler, the site and direction of the regurgitant jet was correctly identified in all compared to intraoperative assessment. Pulsed, continuous, and color flow Doppler are useful as noninvasive techniques in assessing Ionescu-Shiley valve hemodynamics and function.