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WO1997048335A1 - Appareil de detection et d'evaluation du niveau de flux de regurgitation dans une valvule cardiaque - Google Patents

Appareil de detection et d'evaluation du niveau de flux de regurgitation dans une valvule cardiaque Download PDF

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Publication number
WO1997048335A1
WO1997048335A1 PCT/IB1997/000752 IB9700752W WO9748335A1 WO 1997048335 A1 WO1997048335 A1 WO 1997048335A1 IB 9700752 W IB9700752 W IB 9700752W WO 9748335 A1 WO9748335 A1 WO 9748335A1
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WIPO (PCT)
Prior art keywords
blood
thermodilution
magnitude
valve
curves
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Application number
PCT/IB1997/000752
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English (en)
Inventor
Jiri Endrys
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Individual
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Individual
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Publication date
Application filed by Individual filed Critical Individual
Priority to JP10502608A priority Critical patent/JP2000512865A/ja
Publication of WO1997048335A1 publication Critical patent/WO1997048335A1/fr
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/02—Detecting, measuring or recording for evaluating the cardiovascular system, e.g. pulse, heart rate, blood pressure or blood flow
    • A61B5/026—Measuring blood flow
    • A61B5/0275—Measuring blood flow using tracers, e.g. dye dilution
    • A61B5/028—Measuring blood flow using tracers, e.g. dye dilution by thermo-dilution

Definitions

  • the present invention relates to an apparatus for the detection and determination of the magnitude of the regurgitant flow of blood across a heart valve by the use of thermodilution.
  • Defects on heart valves are today normally detect ⁇ ed m the first place by auscultation, i.e. by using a stethoscope. This method is not quantitative, is prone to errors, and it is not possible to determine the magnitude of the regurgitant flow of blood across the heart valve.
  • angiocardiography which is semiquantitative only. It is not providing data of regur- gitant flow m 1/mm.
  • the present invention solves the problems noted above and provides an apparatus for the detection and de- termination of the magnitude of the regurgitant flow of the blood across a heart valve by the use of thermodilution.
  • thermodilution technique two thermodilu ⁇ tion curves are established through measurements from dif ⁇ ferent parts of the heart, i.e upstream and downstream of the valve.
  • the presence of a defect of a heart valve, i.e. a regurgitant flow of blood is detected by the presence of a temperature decrease upstream of the valve, which indi ⁇ cates valvular regurgitation.
  • thermodilution is one of several different techniques to determine cardiac output, but the advantage of thermodilution lies m its simplicity.
  • Thermodilution is one common form of indicator dilution used to obtain carciac output .
  • a thermodilution catheter is placed in e.g. the left half of the heart so that an injection part of the catheter is in the left ventricle and the catheter's two sensors are located upstream and downstream of the valve respectively.
  • thermodilution curves can be plotted and the presence of a measurable cardiac output, or temperature decrease, upstream of the valve indicates valvular regurgitation.
  • the apparatus for the detection and determination of the magnitude of the regurgitant flow of blood across a heart valve by the use of thermodilution comprises means for measuring the tempe ⁇ rature of the blood as a function of time for establishing two different thermodilution curves obtained by measure ⁇ ments from different parts of the heart. Then the thermo- dilution curves are digitized by a digitizing means, e.g. an A/D-converter. The digitized thermodilution curves are then stored in a memory unit connected Lo the digitizing means.
  • the apparatus according to the invention also com ⁇ prises a dectection unit connected to the memory unit for detecting the presence of a temperature decrease upstream of the valve, which indicates valvular regurgitation.
  • the apparatus according to the invention also comprises a cal ⁇ culation means connected to the detection unit for calcula ⁇ tion ⁇ r the first place of the areas below the thermodilu- tion cirves.
  • the calculation means calculates the cardiac output and the magnitude of the regurgitant flow.
  • Fig. 1 is a schematic sectional view of a human heart
  • Fig. 2 is a schematic block diagram of an apparatus according to the present invention.
  • FIG 1 there is disclosed a schematic sec ⁇ tional view of a human heart.
  • the heart is partitioned in a right half and a left half.
  • the right half of the heart comprises the right ventricle RV and the right atrium RA.
  • the left half of the heart comprises the left ventricle LV and the left atrium LA.
  • the inferior vena cava IVC which leads to the right atrium RA and the pulmonary artery PA, which leads to the lungs.
  • the pulmonary vein PV leads to the left atrium LA and the aorta AO leads the blood to the rest of the body.
  • the pulmonary valve PV i.e.
  • the valve between the left atrium LA and the left ventricle LV is called the mitral valve MV
  • the valve between the right atrium RA and the right ventricle RV is called the tricuspid valve TV.
  • Different defects of the valves can cause a regurgitant flow of blood across a heart valve.
  • the regurgitant flow i.e. the back ⁇ wards leakage, causes the measured cardiac output to appear higher than it actually should be.
  • the mitral valve flow MVF is the sum of the cardiac output CO and the mitral regurgitation MR.
  • MVF CO + MR
  • the priciple upon which the themodilution tech- nique . s based is that the change of heat m a substance is related to its mass and specific heat for a given change in temperature. For a static system, where two substances of different temperatures are mixed, the resulting temperature of the mixture will fall between the starting temperatures of the two substances. If the mass of one substance is unknown, it can be determined by equating at equilibrium the change m heat of the two substances and calculating the unknown mass from the resulting equation.
  • thermodilution curve the area below the thermodilution curve repre ⁇ sents the sum of the instantaneously mixed temperatures at the sensing point. Normally, the resulting time-temperature curve is reversed, so the curve is displayed as positive values .
  • a catheter is inserted, e.g. into a large vein and passed along the vein towards and through e.g. the right half of the heart to a point a short distance beyond.
  • the catheter has an orifice to the outside of the catheter and liquid is injected through this orifice into the bloodstream from the far end of the catheter.
  • One or two sensors for measuring the temperature are disposed in the catheter, which sensors are located at different places along the catheter.
  • thermodilution curves To be able to detect and determine the magnitude of the regurgitant flow of blood across a heart valve with the apparatus according to the present invention, two dif ⁇ ferent thermodilution curves have to be recorded.
  • the catheter has to be placed in different locations within the heart, i.e. cold saline is injected into different places and the sensor (s) is/are measuring the temperature at different sites within the heart.
  • cold saline is injected into different places and the sensor (s) is/are measuring the temperature at different sites within the heart.
  • Thermo-probe in pulmonary artery PA - measures cardiac output CO 2. Injection of cole saline into the left ventricle LV
  • Thermo-probe in the left atrium LA - measures mitral regurgitation Measurement of aortic regurgitation A) Simultaneous: Injection of cold saline into the ascending aorta AA
  • Thermo-probe 1st in the descending aorta - measures cardiac output CO
  • Thermo-probe m pulmonary artery PA - measures cardiac output CO
  • Thermo-probe in the left ventricle LV - measures aortic regurgitation Measurement of tricuspid regurgitation
  • Thermo-probe in pulmonary artery PA - measures cardiac output 2. Injection of cold saline into the right ventricle RV Thermo-probe : m the right atrium RA - measures tricuspid regurgitation.
  • both the CO curve and the regurgitation curve can be recorded and calculated after a single injection of cold saline into the left ventricle m patients with mitral regurgitation.
  • the cardie output CO is given by the modified
  • FIG 2 there is disclosed a schematic block diagram of an apparatus 10 according to the present inven ⁇ tion.
  • the apparatus 10 comprises a means 12 for measuring the temperature of the blood as a function of time.
  • the measuring means 12 rceives the thermo-probe-input from the thermo-probe (s) in the catheter.
  • the measuring means 12 is arranged to receive two different thermo-probe-signals simultaneously if the catheter has two thermo-probes (sen- sors) .
  • the measuring means 12 emits an analog signal (or two analog signals respectively) in the form of a thermo ⁇ dilution curve to a digitizing means 14 for digitizing the thermodilution curve (s) .
  • the apparatus 10 also comprises a memory unit 16 connected to the digitizing means 14 for the storing of the digitized thermodilution curve.
  • the memory unit 16 is disposed to store at least two digitized thermo ⁇ dilution curves, because the information contained in two thermodilution curves is needed in order to both detect and determine the magnitude of the regurgitant flow of blood across a heart valve.
  • a detection unit 18 is connected to the memory unit 16 for detecting the presence of a tempera ⁇ ture decrease upstream of the valve, indicating valvular regurgitation.
  • the apparatus 10 also comprises a calcula ⁇ tion means 20 connected to the detection unit 18 for calcu ⁇ lating in the first place the areas below the thermodilu ⁇ tion curves, and in the second place, calculating the car- diac output and the magnitude of the regurgitant flow of blood across a heart valve.
  • the apparatus 10 also comprises a display unit 22 connected to the calculation means 20 and to the memory unit 16.
  • the display unit 22 displays plots of the measured themodilution curves and the magnitude of the regurgitant flow.
  • the digitizing means 14 can be a conventional A/D-converter.

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Measuring Pulse, Heart Rate, Blood Pressure Or Blood Flow (AREA)
  • Engineering & Computer Science (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Physiology (AREA)
  • Biophysics (AREA)
  • Pathology (AREA)
  • Cardiology (AREA)
  • Biomedical Technology (AREA)
  • Physics & Mathematics (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Surgery (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Hematology (AREA)

Abstract

L'invention concerne un appareil (10) de détection et d'évaluation du niveau de flux de régurgitation dans une valvule cardiaque sur la base de la thermodilution. Deux courbes de thermodilution sont établies pour des mesures effectuées sur différentes parties du coeur, en amont et en aval de la valvule. La régurgitation valvulaire est décelée par détection (18) d'une baisse de température en amont de la valvule. On évalue (20) d'abord les domaines situés au-dessous des courbes de thermodilution: les données correspondant à ces zones sont utilisées pour déterminer (20) le débit cardiaque puis le niveau du flux de régurgitation.
PCT/IB1997/000752 1996-06-17 1997-06-16 Appareil de detection et d'evaluation du niveau de flux de regurgitation dans une valvule cardiaque Ceased WO1997048335A1 (fr)

Priority Applications (1)

Application Number Priority Date Filing Date Title
JP10502608A JP2000512865A (ja) 1996-06-17 1997-06-16 心臓弁を横切っての血液逆流の大きさの検出と測定のための装置

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
SE9602389A SE9602389D0 (sv) 1996-06-17 1996-06-17 An apparatus for the detection and determination of the magnitude of the regurgitant flow of blood across a heart valve
SE9602389-0 1996-06-17

Publications (1)

Publication Number Publication Date
WO1997048335A1 true WO1997048335A1 (fr) 1997-12-24

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Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/IB1997/000752 Ceased WO1997048335A1 (fr) 1996-06-17 1997-06-16 Appareil de detection et d'evaluation du niveau de flux de regurgitation dans une valvule cardiaque

Country Status (3)

Country Link
JP (1) JP2000512865A (fr)
SE (1) SE9602389D0 (fr)
WO (1) WO1997048335A1 (fr)

Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CZ303304B6 (cs) * 2010-10-08 2012-07-25 Štásek@Josef Zarízení k provádení merení intrakardiálních zkratu a chlopenních regurgitací

Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US3726269A (en) * 1971-11-24 1973-04-10 W Webster Cardiovascular catheter for thermal dilution measurement
US3987788A (en) * 1975-07-09 1976-10-26 American Hospital Supply Corporation System for computing cardiac flow rates from thermodilution measurements
US4417588A (en) * 1982-03-22 1983-11-29 Critikon, Inc. Apparatus and method for initiating cardiac output computations
US5595181A (en) * 1994-03-24 1997-01-21 Hubbard; A. Robert System for providing cardiac output and shunt quantitation

Patent Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US3726269A (en) * 1971-11-24 1973-04-10 W Webster Cardiovascular catheter for thermal dilution measurement
US3987788A (en) * 1975-07-09 1976-10-26 American Hospital Supply Corporation System for computing cardiac flow rates from thermodilution measurements
US4417588A (en) * 1982-03-22 1983-11-29 Critikon, Inc. Apparatus and method for initiating cardiac output computations
US5595181A (en) * 1994-03-24 1997-01-21 Hubbard; A. Robert System for providing cardiac output and shunt quantitation

Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CZ303304B6 (cs) * 2010-10-08 2012-07-25 Štásek@Josef Zarízení k provádení merení intrakardiálních zkratu a chlopenních regurgitací

Also Published As

Publication number Publication date
SE9602389D0 (sv) 1996-06-17
JP2000512865A (ja) 2000-10-03

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