Preoperative Left Ventricular Energy Loss in the Operating Theater Reflects Subjective Symptoms in Chronic Aortic Regurgitation

Figures

• 

  Figure 1. Visualization of blood flow energy loss and blood flow by vector flow mapping. These figures show EL. Brightness indicates high energy loss. The AR jet collides with mitral inflow, which causes left ventricular vortex turbulence and high dissipative EL. (A) Asymptomatic case (NYHA I), (B) symptomatic case (NYHA III). Early diastole, The early phase of the diastolic period; Systolic, Systolic phase; IVCT, The isovolumic contraction phase; IVRT, The isovolumic relaxation phase; Late diastole, The late phase of the diastolic period.

• 

  Figure 2. The graph shows an example of intraventricular flow energy loss distribution during one cardiac cycle. The blue curve represents the asymptomatic case (NYHA I) and red represents the symptomatic case (NYHA III). MC, mitral valve closing; MO, mitral valve opening.

• 

  Figure 3. Main findings of this study. Black dots represent symptomatic patients, whereas white dots represent asymptomatic patients. The mean energy loss of one cardiac cycle is higher in the symptomatic group than in the asymptomatic group (p = 0.040) (A). The diastolic diameter is higher in the asymptomatic group than in the symptomatic group (p = 0.040) (B). mEL, mean energy loss in one cardiac cycle. *p < 0.05.

• 

  Figure 4. Schematics of LV vortex interaction in diastole. (A) The intramitral flow organizes itself in a circulatory pattern that redirects the flow to the aorta. (B) The AR jet collides with the transmitral flow and merges with it. (C) The AR jet inhibits the formation of the optimal left ventricular vortex. (D) The LV cavity is enlarged, and the AR jet and the transmitral flow merge. Abbreviations: AR, aortic regurgitation; LA, left atrium; Ao, aorta; LV, left ventricle.