Prediction of stenotic valve orifice area: an in vitro study on a bioprosthesis

The Gorlin equation for the hemodynamic assessment of valve area is commonly used in cardiac catheterization laboratories. A study was performed to test the prediction capabilities of the Gorlin formula, as well as those of the Aaslid and Gabbay formulas for the effective orifice area of a porcine valve of varying degrees of stenosis. Pressure gradient, flow, and valve opening area measurements were performed on Carpentier-Edwards porcine valve prostheses (made stenotic by suturing at the commissures) mounted in the aortic position of an in vitro pulse duplicator. With the known valve orifice area, a discharge coefficient was computed for each of the three orifice area formulas. After some theoretical considerations, it was proposed that the discharge coefficient would be a function of the flow rate through the valve. The discharge coefficient was observed to increase with increasing systolic flow rate. An empirical relationship of the discharge coefficient as a linear function of the systolic flow rate was determined through a regression analysis, with a different relationship for each orifice area formula. Using this relationship in the orifice area formulas improved the accuracy of the prediction of the effective orifice area with all three formulas performing equally well.