Real-time Two-dimensional Doppler Flow Imaging Research Articles

A case of a large right coronary-right atrial fistula. Real-time two-dimensional doppler flow imaging and nuclear magnetic resonance computed tomography

A case of a large right coronary-right atrial fistula. Real-time two-dimensional doppler flow imaging and nuclear magnetic resonance computed tomography

Accurate Localization of Ruptured Sinus of Valsalva Aneurysm by Real-time Two-dimensional Doppler Flow Imaging

The surgical approach to the repair of a ruptured sinus of Valsalva aneurysm can depend on the cardiac chamber into which rupture occurs. This report details the color flow Doppler images in two patients who developed a right sinus of Valsalva aneurysm to right atrial fistula owing to bacterial endocarditis. In both cases, the color flow Doppler image was superior to contrast aortography in identifying the chamber into which rupture had occurred. The early experience with real-time two-dimensional Doppler flow imaging suggests that this noninvasive technique is valuable in the management of ruptured sinus of Valsalva aneurysms.

Diagnosis of valve perforation by real-time two-dimensional Doppler flow imaging:

Diagnosis of valve perforation by real-time two-dimensional Doppler flow imaging:

Mechanism of mitral regurgitation in patients with myocardial infarction: a study using real-time two-dimensional Doppler flow imaging and echocardiography.

The aim of the present study was to elucidate the mechanisms of mitral regurgitation accompanying myocardial infarction. Severity and site of mitral regurgitation was evaluated by the real-time two-dimensional Doppler flow imaging technique in 81 patients with old myocardial infarction. The incidence of mitral regurgitation did not depend on the region of infarction. There was, however, a close relationship between the site of regurgitation and the region of infarction. In patients with mitral regurgitation spurting from the posteromedial area of the valve, the inferior wall was involved in infarction without exception and in some of these patients, the posteromedial papillary muscle was also found to be affected by myocardial infarction; in those with regurgitation spurting from the anterolateral area, the anterior wall showed asynergy. On the other hand in patients with mitral regurgitation spurting from the central area, the region of infarction varied. In these patients, however, the larger the diameter of the mitral anulus, the more severe the grade of regurgitation. The extent of asynergy was another factor related to the severity of mitral regurgitation. Both longitudinally and transversely, broad infarction leads to the enlargement of the mitral anulus. However, even if the mitral anulus is not so dilated, severe involvement of either commissural area results in severe mitral regurgitation from the same commissural side. Thus, there are two major causative factors of mitral regurgitation: (1) asynergy of the papillary muscle or the ventricle that results in mitral regurgitation located in the commissural area of the same side as asynergy, and (2) enlargement of mitral anulus, which results in regurgitation from the central area of the orifice.(ABSTRACT TRUNCATED AT 250 WORDS)

Diagnosis of mitral valve perforation by real-time two-dimensional Doppler flow imaging technique

It has been difficult to diagnose mitral regurgitation due to valve perforation using either noninvasive or invasive methods, differentiating it from that resulting from incomplete coaptation of the mitral valve. This report describes three patients with infective endocarditis and mitral valve perforation, which was definitively diagnosed by the real-time two-dimensional Doppler flow imaging technique. In these three patients, B-mode echocardiography demonstrated an echo interruption on the anterior mitral leaflet. However, it was not certain whether this interruption was simply an echo dropout or indicated an interruption of the valve tissue. Doppler flow imaging then demonstrated unusual flow in the vicinity of the echo interruption, which appeared to flow from the left ventricular cavity into the left atrial cavity across the midportion of the anterior mitral valve leaflet during systole and in the opposite direction during diastole. This was interpreted as mitral valve perforation. In general, Doppler flow imaging may play a complementary role with B-mode echocardiography in cardiac diagnosis.

Right atrial flow topography in healthy subjects studied with real-time two-dimensional Doppler flow imaging technique

The pattern of normal blood flow in the right atrial cavity was studied using the newly developed real-time two-dimensional Doppler flow imaging technique as a standard reference for the Doppler diagnosis of heart diseases with intracardiac shunts at the atrial level. The study was performed primarily with use of the apical four chamber and the parasternal right ventricular inflow tract views in 21 healthy subjects. The following patterns were observed: blood from the inferior vena cava flowed up along the posterior wall of the right atrium and joined with blood from the superior vena cava in the posterocranial part of the right atrial cavity; the flow then coursed along the roof of the right atrium toward the tricuspid valve in the atrial relaxation phase. This flow was always noted along the interatrial septum in the four chamber view. During and after mid-systole of the right ventricle, additional blood flow away from the tricuspid valve appeared, moving from the valve to the central part of the right atrial cavity, that is, at the lower right of the preceding inflow; this flow was interpreted as arising from eddy currents caused by the preceding inflow. In early diastole of the right ventricle, the flow signal area along the interatrial septum and the roof of the right atrium extended into the right ventricular cavity through the tricuspid valve. In the atrial contraction phase only the blood near the tricuspid valve in the right atrial cavity appeared to flow into the right ventricular cavity. Inflow from the coronary sinus was almost undetectable.(ABSTRACT TRUNCATED AT 250 WORDS)

Semiquantitative grading of severity of mitral regurgitation by real-time two-dimensional Doppler flow imaging technique

An attempt was made to determine whether mitral regurgitation could be detected and its severity evaluated semiquantitatively by newly developed real-time two-dimensional Doppler flow imaging in 109 patients who underwent left ventriculography. In the Doppler flow imaging technique, Doppler signals due to blood flow in the cardiac chambers are processed using a high speed autocorrelation technique, so that the direction, velocity and turbulence of the intracardiac blood flow are displayed in the color-coded mode on the monochrome B-mode echocardiogram in real time. Mitral regurgitant flow was imaged as a jet spurting out from the mitral valve orifice into the left atrial cavity. It was noted that the regurgitant jet in the left atrial cavity had a variety of orientations and dynamic features when studied by the present technique. The sensitivity of the technique in the detection of mitral regurgitation was 86% as compared with that of left ventriculography. Mitral regurgitation in the false negative cases was mostly mild. On the basis of the farthest distance reached by the regurgitant flow signal from the mitral valve orifice, the severity of regurgitation was graded on a four point scale and these results were compared with those of angiography. A significant correlation (r = 0.87) was found between Doppler imaging and angiography in the evaluation of the severity of mitral regurgitation. A similar result was obtained for the evaluation based on the area covered by the regurgitant signals in the left atrial cavity. Thus, noninvasive semiquantitative evaluation by real-time two-dimensional Doppler flow imaging appears to be a promising clinical technique.

Recent progress in ultrasonic diagnosis of the heart: Doppler flow imaging.

It is appreciated that, linked with B-mode echocardiography, the real-time two-dimensional Doppler flow imaging technique provides information on the heart, which has never been available with conventional methods, greatly improving the capabilities of cardiac ultrasound. In general, the concept of major heart disease consists of anatomical abnormalities and those in intracardiac flow condition. The present method provides information on these two aspects simultaneously; consequently, it is regarded as a closer approach to heart diseases, compared with conventional examinations and techniques. The equipment is also convenient to operate. The combination of real-time two-dimensional Doppler flow imaging and B-mode echocardiography is expected to become a standard tool of the ultrasound examination of the heart.

Clinical applications of a new type of real-time two-dimensional doppler flow imaging system

The clinical significance of a newly developed real-time 2-dimensional (2-D) Doppler flow imaging technique was assessed. In the instrumentation of the echocardiograph, the pulsed Doppler mechanism was incorporated in a wide-angle, phased-array system. The Doppler flow signals obtained from the cardiac chamber were processed on the basis of the autocorrelation principle. The direction, velocity and variance of the intracardiac blood flow were calculated in real time and displayed in the color-coded mode on the television screen, and were superimposed on the 2-D echocardiographic image of the heart. The technique was used in 20 healthy subjects and 100 cardiac patients. The new technique clearly visualized the whole aspect of intracardiac blood flow by the cine mode in real time; thus, the technique may be called Doppler cineangiocardiography. The mitral inflow and the aortic ejection flow were clearly demonstrated. A regurgitant jet from the valve orifices was dynamically visualized as seen in the cineangiogram. The spatial orientation and extent of the regurgitant jet were easily assessed. The jet stream through the stenotic mitral orifice was well imaged in the left ventricular cavity, showing a variety of stream directions. Intracardiac shunts in ventricular septal defect and atrial septal defect were clearly visualized. The defect could be localized on the interventricular septum on the basis of the site where the shunt flow spurted, although the echocardiographic interruption was not demonstrated in the 2-D echocardiographic image of the cardiac structure. Although some technical problems remain, our new technique greatly improves the diagnostic efficacy of ultrasound.