Armelin, E

The distances between the aortic valve and sites in the aorta from which no retrograde flow of injected indicator could be detected in the left ventricle were determined, without thoracotomy, in two normal dogs and in ten dogs with chronic experimental aortic regurgitation. It was found that these distances attained maximal values when the aortic injections were timed to occur just at the end of systole or onset of diastole. Distances downstream from the origin of the left subclavian artery from which no retrograde flow occurred to this vessel were determined similarly in these same animals and, in confirmation of Warner and Toronto, similar relationships to the timing of the injections were obtained. These distances down the aorta, designated as "disappearance distances", were converted to "disappearance volumes" by measuring the diameters of the silhouette of successive aortic segments from aortograms made after contrast medium was injected into the left ventricle of these animals. The regurgitant flow through the aortic valve per heartbeat was estimated on the basis of the amount of immediately appearing indicator detected in the left ventricle following injection of indicator approximately 1 cm downstream from the aortic valve. Correlation coefficients of 0.88 and 0.77 were obtained between these stroke-regurgitation values and the disappearance volumes from the aortic valve and subclavian artery, respectively. The standard errors of the estimate of the regurgitant flow per beat from these regression equations were ± 2.7 and ± 2.9 ml/beat, respectively. The correlation coefficients between stroke-regurgitation values and the disappearance distances from the valve and subclavian artery were 0.83 and 0.81, respectively, and the respective standard errors of the estimate of stroke regurgitation from these regression equations were ± 3.2 and ± 3.3 ml/beat. It is concluded that determination of the maximal distances downstream in the aorta of sites from which retrograde flow of injected indicator can be detected in the left ventricle or subclavian artery is a valid method for estimating the severity of experimental aortic regurgitation in dogs. Since determinations of the disappearance distance from the aortic valve can be carried out readily in conjunction with measurement of the left ventricular regurgitation fraction, it is suggested that advantage be taken of the increase in reliability which accrues from the combined use of these two independent methods for the estimation of the degree of aortic regurgitation.

In dogs studied without thoracotomy the detection of immediately appearing indicator in the left ventricle following its injection approximately 1 cm downstream from the aortic valve can be used as a reliable index of the presence or absence of aortic regurgitation. With this type of injection and under the conditions of these experiments, the ratio of the area encompassed by the immediately appearing portion of the dilution curve recorded from the left ventricle to the area encompassed by the primary portion of the curve recorded at the femoral artery bears a close positive correlation (correlation coefficient: 0.9) to the severity of aortic regurgitation as estimated by back perfusion of the valve at necropsy. Within limitations, the position of the tip of the sampling catheter in the left ventricle in dogs with aortic regurgitation is not an important determinant of the amount of immediately appearing indicator detected in this chamber. Furthermore, although the amount of indicator detected in the left ventricle following injections of very short duration is time-dependent, if the duration of the injection is extended to cover the full systolic or diastolic phase of one heartbeat or continues over one or more heartbeats, the exact timing of this injection in relation to the cardiac cycle is not an important determinant of this variable. It is concluded that under these conditions the positive correlation established between the amount of immediately appearing dye detected in the left ventricle (expressed as the regurgitant fraction) and the severity of aortic regurgitation determined by back perfusion at necropsy can be used as a valid means of estimating the severity of aoritic regurgitation in dogs. The applicability of this indicator-dilution method to the study of clinical aortic reguragitation merits further study.