How sensitive are jet centerline velocities to an opposing flow? Implications for using the centerline method to...

A method for quantifying peak mitral and tricuspid regurgitant jet flow rate that utilizes a measure of jet orifice velocity (Uo, m s-1), a distal centerline velocity (Um, m s-1), and the intervening distance (X, cm) was recently developed. This method, however, modeled the regurgitant jet as a free jet, whereas many atrial jets are counterflowing jets because of jet opposing intra-atrial flow fields (counterflows). This study evaluated the feasibility of using the free jet quantification equation in the atrium where ambient flow fields may alter jet centerline velocities and therefore reduce the accuracy of jet flow rate calculations. A 4 cm wide chamber was used to pump counterflows of 0, 4, and 22 cm s-1 against jets of 2.3, 4.8, and 6.4 s-1 originating from a 2 mm diameter orifice. For each counterflow-jet combination, jet centerline velocities were measured using laser Doppler anemometry. For free jets (no counterflow), flow rate was calculated with 98% mean accuracy. For all jets in counterflow, the calculation was less accurate as (i) the ratio of jet orifice velocity to counterflow velocity decreased (Uo/Uc, where Uc is counterflow velocity), i.e. the counterflow was relatively more intense, an (ii) centerline measurements were mad further from the orifice. But although counterflow lowered jet centerline velocities beneath free jet values, it did so only significantly in the jet's distal portion, while the initial portion (X/D < 16, where D is jet orifice diameter) of a jet in counterflow behaved essentially as a free jet. Therefore, regurgitant jets, although not classically free because of systolic atrial inflow, will decay in their initial portions as free jets and hence are candidates for quantification with the centerline technique.