In vitro verification of Doppler prediction of transvalve pressure gradient and orifice area in stenosis.

This study was designed to analyze the validity of application of the modified Bernoulli equation (pressure gradient = 4.0 X velocity2) for estimating the pressure drop and valve orifice area from the jet velocity measured by Doppler ultrasound. We used an in vitro model which permitted interchangeable orifices, accurate measurement of the valve area and pressure drop across the valve. An in-line Doppler ultrasound transducer measured jet velocity (VEL D) at various water flow rates at an incident angle of 180 degrees beyond the various tested orifices. Jet velocity was also determined independently by application of a modified Bernoulli equation using the experimentally measured pressure drop (VEL P) and by a standard continuity equation (VEL Q). VEL P correlated very closely with VEL D (r = 0.981, standard error of the estimate [SEE] = 17.0 and slope of the regression = 0.988). VEL Q, corrected for vena contracta effects, correlated with VEL P (r = 0.986, SEE = 21.6), but had a slope of 0.673. To experimentally determine the exponent of velocity in the Bernoulli equation, we plotted pressure drop against VEL D and found a value of 2.11; theory predicts 2.0. Experimental coefficient of velocity was 3.36 torr/m (standard deviation = 0.52), whereas theory predicts 3.75 for water. Orifice area, calculated using VEL D and the continuity equation, was consistently overestimated by 3 to 12% for flows that produced laminar jets. The pressure gradient and orifice areas calculated from Doppler-derived data accurately predict actual pressure gradients and orifice areas.