Effect of mitral regurgitation and aortic regurgitation on Doppler-derived mitral orifice area in patients with mitral stenosis.

Traditional Doppler pressure half-time (T1/2) method (mitral valve area = 220/T1/2) is widely used for evaluating the mitral orifice area in patients with mitral stenosis (MS). However, the effect of mitral regurgitation (MR) and aortic regurgitation (AR) on the calculation of the mitral valve area by this method is still controversial. Therefore, we examined 493 consecutive patients with MS to evaluate the effect of MR and AR on Doppler-derived mitral orifice area. The mitral orifice area planimetered from two-dimensional echocardiogram was used as the standard reference. Excluding 16 patients with either unsatisfactory Doppler or echocardiographic tracings, 477 patients were enrolled in the study. There were 162 males and 315 females with a mean age of 49 years. They were divided into 4 groups: group A, 327 patients with MS but no MR and AR; group B, 68 patients with MS + MR but no AR; group C, 64 patients with MS + AR but no MR; group D, 18 patients with MS + MR + AR. The differences between echo and Doppler area were 0.02 +/- 0.02 cm2 (mean +/- SE), p = 0.220, in group A; 0.13 +/- 0.04 cm2, p = 0.004, in group B; 0.11 +/- 0.05 cm2, p = 0.026 in group C; and 0.31 +/- 0.08 cm2, p = 0.001, in group D. Thus, in patients with MS, the associated MR or AR may invalidate the pressure half-time method for the derivation of mitral valve area.