Transthoracic Doppler Color Flow Imaging

Combined echocardiography and Doppler color flow mapping from transthoracic imaging windows has become the standard method for the noninvasive assessment of valvular regurgitation. This study compared regurgitant jet areas by Doppler color flow imaging derived from the newer transesophageal approach with measurements obtained from conventional transthoracic apical views. Maximal regurgitant jet area determinations and an overall visual estimate of lesion severity were obtained from 42 patients who underwent color flow examination by both techniques. Seventy-three regurgitant lesions were visualized by transesophageal flow imaging: 34 mitral, 22 aortic, and 17 tricuspid jets. Transthoracic studies in the same patients revealed fewer regurgitant lesions for each valve: 20 mitral, 16 aortic, and 12 tricuspid (p=0.0009). A comparison of maximal jet areas determined by transesophageal and transthoracic studies showed a good overall correlation (r=0.85, SEE=2.8 cm2) and a systematic overestimation by the transesophageal technique (TEE=0.96 TTX+2.7). For the subgroup with mitral insufficiency, valve lesions visualized by both techniques were larger by the transesophageal approach (n= 18, 6.0 versus 3.6 cm2, p =0.008). Semiquantitative visual grading of individual valve lesions by two independent observers revealed a higher grade of regurgitation with more jets classified as mild (38 versus 25), moderate (18 versus 13), and severe (17 versus 10) by esophageal imaging than by transthoracic imaging. Thus, transesophageal color flow mapping techniques yield a higher prevalence of valvular regurgitation than do transthoracic techniques in the same patients. Jet area and the overall estimate of regurgitant lesion severity were also greater by transesophageal color Doppler imaging compared with standard transthoracic imaging. As a result, currently used standards for predicting severity of regurgitation by Doppler color flow mapping must be reexamined when the esophageal window is used. (Circulation 1991:83:79-86)