Pulsed Doppler Examination Research Articles

Hemodynamic compromise (tricuspid stenosis and insufficiency) caused by an unruptured aneurysm of the sinus of Valsalva

A patient is described with an unruptured aneurysm of the noncoronary sinus of Valsalva that occupied the right ventricular inflow tract and caused dynamic tricuspid stenosis and insufficiency. Results of two-dimensional echocardiography delineated the anatomy of the aneurysm and pulsed Doppler examination provided evidence that the aneurysm was unruptured. The unruptured aneurysm was resected successfully.

Doppler evaluation of left ventricular diastolic filling in children with systemic hypertension

To assess left ventricular (LV) diastolic function in children with systemic hypertension, 11 patients with hypertension (mean blood pressure 99 mm Hg) and 7 normal patients (mean blood pressure 78 mm Hg) underwent M-mode echocardiography and pulsed Doppler examination of the LV inflow. From a digitized trace of the LV endocardium and a simultaneous phonocardiogram, echocardiographic diastolic time intervals, peak rate of increase in LV dimension ( dD dt ), and dD dt normalized for LV end-diastolic dimension ( dD dt ) were measured. Doppler diastolic time intervals, peak velocities at rapid filling (E velocity) and atrial contraction (A velocity), and the ratio of E and A velocities were measured. The following areas under the Doppler curve and their percent of the total area were determined: first 33% of diastole (0.33 area), first 50% of diastole, triangle under the A velocity (A area), and the triangle under the E velocity (E area). The A velocity (patients with hypertension = 0.68 ± 0.11 m/s, normal subjects = 0.49 ± 0.08 m/s), the 0.33 area/total area (patients with hypertension = 0.49 ± 0.09, normal subjects = 0.58 ± 0.08), the A area (patients with hypertension = 0.17 ± 0.05, normal subjects = 0.12 ± 0.03), and the A area/total area (patients with hypertension = 0.30 ± 0.11, normal subjects = 0.20 ± 0.07) were significantly different between groups (p < 0.05). M-mode and Doppler time intervals, dt D , E velocity, and the remaining Doppler areas were not significantly different between groups. The normal subjects and patients with hypertension did not differ significantly in echocardiographic LV size and thickness or in percent shortening fraction. This study shows that abnormal patterns of LV diastolic filling occur in children with mild systemic hypertension. These diastolic abnormalities are detectable by mitral valve Doppler ultrasound examination when standard M-mode echocardiographic indexes of diastolic function are still normal and before the development of systolic function abnormalities or LV hypertrophy on the M-mode echocardiogram.

95 GATED PULSED DOPPLER ASSESSMENT OE SIMPLE COARCTATION IN OF THE AORTA IN PEDIATRIC PATIENTS

Pulsatile flow dynamics are altered distal to an area of obstruction. To investigate the effects of simple coarctation of the aorta (CAo) on descending aortic blood flow patterns, doppler interrogation of the thoracoabdominal aorta was performed in 12 infants with CAo less than 18 months of age, and 15 age matched controls. All patients with CAo demonstrated continuation of high forward flow throughout the cardiac cycle with prolongation of both acceleration and deceleration phases. Indexing the ratio of acceleration and deceleration phases of flow with acceleration time, measured as the time from onset of flow to peak frequency corrected for cycle length, separated CAo patients from normal subjects. In contrast, doppler frequency distributions from the ascending aorta did not distinguish CAo from controls. In conclusion, gated pulsed doppler examination of the thoracoabdominal aorta displayed a frequency distribution specific for coarctation of the aorta. The discrepancy between ascending and descending frequency distributions represents systolic loading and diastolic decompression of the obstructed proximal thoracic aorta. This method can provide a useful adjunct to serial follow-up of coarctation patients and early detection of recoarctation.

Mitral valve prolapse secondary to right ventricular enlargement in patients with pulmonary hypertension after toxic rapeseed oil ingestion

A high incidence of mitral valve prolapse (MVP) has been reported in various entities which produce important right ventricular (RV) enlargement with normal or decreased left ventricular (LV) volume. To evaluate the importance of RV enlargement in the genesis of MVP in these cases, we analyzed the echocardiographic studies from 176 patients with 'Síndrome Tóxico'. These patients underwent M-mode, cross-sectional and pulsed Doppler examination because of the suspicion of having dietary pulmonary hypertension, a complication which occurred in almost 20% of patients with this epidemic poisoning and which showed a course of gradual resolution in most of them. RV size was classified according to the RV/LV maximal short-axis dimension ratio as normal, border-line, moderately enlarged and severely enlarged. MPV was diagnosed according to standard M-mode and cross-sectional echocardiographic criteria. A second echocardiographic examination was obtained in 38 patients 12.5 +/- 5.3 months after the first one. The incidence of MVP was 9.3% in patients with normal RV size (N = 107), 9.5% in patients with border-line RV size (N = 23), 30% in patients with moderate RV enlargement (N = 30) and 56% in patients with severe RV enlargement (N = 16) (P less than 0.001). Fourteen (77%) of the 18 patients with MVP and moderate or severe RV enlargement (N = 16) (P less than 0.001). Fourteen (77%) of the 18 patients with MVP and moderate or severe RV enlargement had holosystolic MVP. At pulsed Doppler examination, no patient showed signs of mitral regurgitation.(ABSTRACT TRUNCATED AT 250 WORDS)

Absence of the aortic valve: Antenatal and postnatal two-dimensional and Doppler echocardiographic features

Antenatal and postnatal two-dimensional and gated pulsed Doppler echocardiography, beginning at 32 weeks' gestation, were used to evaluate the cardiovascular contribution to nonimmunologic hydrops in a gravida 1, para 0 nineteen year old woman. Antenatal two-dimensional imaging demonstrated a hypoplastic left heart variant of complete common atrioventricular (AV) canal. Antenatal gated pulsed Doppler examination of the fetal thoracoabdominal aorta revealed atypical pandiastolic retrograde flow. Postnatal noninvasive examination at 36 weeks' gestational age was unchanged from the prenatal study. Postmortem examination confirmed the noninvasive anatomic findings and revealed polysplenia. The mechanism of pandiastolic retrograde flow was attributable to "absence of the aortic valve," a previously unreported congenital cardiac anomaly, which resulted in severe antenatal and postnatal aortic regurgitation.

Range gated echo-Dopplervelocity and turbulence mapping in patients with valvular aortic stenosis

Flow beyond a stenotic aortic valve (AS) is dynamically complex. Numerous hydraulic studies have demonstrated that at least four well-known major flow areas occur distal to a stenotic valve. These include a jet, an area alongside the jet (the parajet), an area of flow disturbance, and an area in which disturbed flow again becomes laminar downstream. Of these, only the flow disturbance area has markedly turbulent flow, although some turbulence can be at times detected in the area beside the jet. The purpose of this investigation was to test a technique of patient examination that might allow a range-gated pulsed Doppler to detect each of these known areas in the aorta (Ao) of valvular AS patients. A method for mapping flow in the lumen of the Ao root and ascending Ao is detailed. The transverse Ao arch was studied in the standard manner. With this mapping method, 14 patients with AS were studied. We were able to identify the jet in 13 of 14 as a high velocity, narrow-width signal in the Ao root. The parajet area was characterized by no detectable or low flow in 12 of 14, but two patients had late systolic flow disturbance in the parajet area. All patients ahd a strong flow disturbance detected; 3 of 14 were first detected in the Ao root and the remainder were first detected higher in the ascending Ao. The area of relaminarization was not addressed in this study. This investigation demonstrates that a proper interpretation of range-gated pulsed Doppler recordings from areas distal to AS requires knowledge of flow dynamics beyond an obstruction and a methodical range-gated pulsed Doppler examination technique.

Real-time ultrasound and pulsed Doppler evaluation of the retroplacental clear area.

The retroplacental clear area is a hypoechoic region at the placental-endometrial interface which is frequently demonstrated with high-resolution equipment. During pulsed Doppler examination of the retroplacental clear area, venous signals were obtained in 26 of 27 cases. This is strong evidence that this region is composed of dilated veins.

Pulsed Doppler echocardiographic detection of total anomalous pulmonary venous return: Resolution of left atrial line

During precatheterization M mode echocardiographic examination, 33 infants were identified as having findings including right ventricular enlargement and presence of a line within the left atrial portion of the M mode tracing suggesting the possibility of cor triatriatum or total anomalous pulmonary venous return. Pulsed Doppler echocardiography was used to sample blood characteristics on either side of the left atrial line to determine which line was artifactual and which was indicative of an important structure. Five patients whose blood flow characteristics were different on either side of the left atrial line were subsequently proved to have total anomalous pulmonary venous return at cardiac catheterization. In the remaining infants blood flow characteristics were identical on either side of the line, and catheterization excluded total anomalous pulmonary venous return and cor triatriatum. In all patients who had total anomalous pulmonary venous return, drainage involved a persistent left superior vena cava, and this vascular structure was identified by pulsed Doppler examination from the suprasternal notch. Pulsed Doppler echocardiography appears to be a useful technique for resolution of left atrial lines found on M mode echocardiography.