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Cardiology Research and Practice
Volume 2012, Article ID 383217, 4 pages
http://dx.doi.org/10.1155/2012/383217
Review Article

Nonconvective Forces: A Critical and Often Ignored Component in the Echocardiographic Assessment of Transvalvular Pressure Gradients

1Division of Cardiac Surgery, The Ohio State University Medical Center, Columbus, OH 43210, USA
2Department of Anesthesiology, The Ohio State University Medical Center, Columbus, OH 43210, USA

Received 11 May 2011; Accepted 14 August 2011

Academic Editor: Anthony McLean

Copyright © 2012 Michael S. Firstenberg et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Echocardiography is routinely used to assess ventricular and valvular function, particularly in patients with known or suspected cardiac disease and who have evidence of hemodynamic compromise. A cornerstone to the use of echocardiographic imaging is not only the qualitative assessment, but also the quantitative Doppler-derived velocity characteristics of intracardiac blood flow. While simplified equations, such as the modified Bernoulli equation, are used to estimate intracardiac pressure gradients based upon Doppler velocity data, these modified equations are based upon assumptions of the varying contributions of the different forces that contribute to blood flow. Unfortunately, the assumptions can result in significant miscalculations in determining a gradient if not completely understood or they are misapplied. We briefly summarize the principles of fluid dynamics that are used clinically with some of the inherent limitations of routine broad application of the simplified Bernoulli equation.