Pulmonary atresia with an intact septum: indications for the neonatal surgical treatment guided by 2-dimensional and Doppler echocardiography

Twelve neonates with pulmonary atresia and intact ventricular septum underwent surgical treatment based on two-dimensional and Doppler echocardiography. Ten patients with adequate morphology of the right ventricular outflow tract portion shown by means of two-dimensional echocardiography underwent pulmonary valvulotomy and systemic-to-pulmonary shunt. Two neonates with atresia of the right ventricular infundibulum on two-dimensional echocardiography underwent systemic-to-pulmonary artery shunt without valvulotomy. In all patients the qualitative and quantitative echocardiographic diagnosis was confirmed at surgery and/or with the subsequent angiocardiographic study. Two-dimensional and Doppler echocardiography is a precise diagnostic method for planning surgical treatment in neonates with pulmonary atresia and intact ventricular septum.     

Usefulness of color Doppler in the diagnosis of ventricular septal rupture after myocardial infarction

Ten consecutive patients with ventricular septal rupture complicating acute myocardial infarction were studied by means of Doppler echocardiography (including two-dimensional, conventional and color Doppler techniques) and bedside right heart catheterization using a Swan-Ganz catheter. One patient died before an operation could be performed. Seven critically ill patients underwent emergency cardiac surgery without preoperative cardiac catheterization, while in two patients it was also possible to undertake coronary angiography before surgery. Two-dimensional echocardiography diagnosed post-infarction ventricular septal rupture in 6 out of 10 patients. Color Doppler revealed the presence and the location of septal rupture in all 10 patients. The color Doppler diagnosis was confirmed either by surgery or necropsy. The estimates of pulmonary artery pressure, obtained by color Doppler-guided continuous wave Doppler beam, were very close to those measured by simultaneous right heart catheterization. In 3 patients, patch leakage occurred 3 days, 15 days and 1 year after the operation. Two-dimensional echocardiography revealed the patch leakage in only one of 3 patients while its location was visualized by color Doppler in all 3 patients. In one patient the color Doppler diagnosis was confirmed at necropsy. In the remaining 2 patients, a small left-to-right shunt was demonstrated by radionuclide studies. Color Doppler echocardiography is a highly sensitive and rapid technique in the diagnosis of postinfarction ventricular septal rupture. In critically ill patients it offers relevant information and may obviate the need for any invasive preoperate investigation.     

原位心脏移植肺动脉压及右心功能的彩色多普勒超声评价

目的 探讨终末期扩张型心肌病病人心脏移植术前和术后早期肺动脉压和右心功能的临床意义。方法 近2年6例心脏移植病人,术前和术后3～7d用彩色多普勒超声测量右心室前后径、右心室射血分数、肺动脉收缩压与舒张压、心包积液和三尖瓣反流程度。回顾分析术前肺动脉压和右心功能对术后早期右心功能和肺动脉压的影响。结果 术前肺动脉高压病人右心室前后径增加（r=0.8227,n=6）,右心室射血分数减少（r=-0.7361,n=6）。肺动脉压升高是引起右心扩大和衰竭的重要因素;术前肺动脉高压患者术后有明显下降,但仍处于高值;术前肺动脉压与术后右心室和肺动脉径和右心室射血分数改变不显著;术后三尖瓣反流和心包积液与术前和术后肺动脉压有关。结论 手术前后应用彩色多普勒超声评估肺动脉压对心脏移植术前受体选择和早期术后恢复具有重要的临床意义。彩色多普勒超声测量肺动脉压和右心功能简便易行,重复性较好。     

Comparison of Doppler derived haemodynamic variables and simultaneous high fidelity pressure measurements in severe pulmonary hypertension.

OBJECTIVE--To assess relations between right ventricular pressure measured with a high fidelity transducer tipped catheter and the characteristics of tricuspid regurgitation recorded with Doppler echocardiography. DESIGN--A prospective non-randomised study of patients with severe pulmonary hypertension referred for consideration of lung transplantation. SETTING--A tertiary referral centre for cardiac and pulmonary disease, with facilities for invasive and non-invasive investigation, and assessment for heart and heart-lung transplantation. PATIENTS--10 patients with severe pulmonary hypertension being considered for lung transplantation. ENDPOINTS--Peak right ventricular, pulmonary artery, and right atrial pressures; peak positive and negative right ventricular dP/dt; peak Doppler right ventricular-right atrial pressure drop; Doppler derived peak positive and negative right ventricular dP/dt; and time intervals of Q to peak right ventricular pressure and to peak positive and negative right ventricular dP/dt. RESULTS--The mean (SD) pulmonary artery systolic pressure was 109 (29) mm Hg. The peak Doppler right ventricular-right atrial pressure drop underestimated peak right ventricular pressure by 38 (21) mm Hg, and by 21 (18) mm Hg when the Doppler value was added to the measured right atrial pressure (P values < 0.05). This discrepancy was greater for higher pulmonary artery pressures. The timing of peak right ventricular pressure differed, with the Doppler value consistently shorter (mean difference 16 ms, P < 0.05). Values of peak positive and negative right ventricular dP/dt and the time intervals Q-peak positive right ventricular dP/dt and pulmonary closure to the end of the pressure pulse differed between the two techniques in individual patients, but not in a consistent or predictable way. CONCLUSIONS--Doppler echocardiography significantly underestimates the peak right ventricular pressure and the time interval to peak right ventricular pressure in pulmonary hypertension, particularly when severe. These differences may be related to orifice geometry. Digitisation of Doppler records of tricuspid regurgitation provides useful semiquantitative estimates of absolute values and timing of peak positive and negative right ventricular dP/dt. Clinically significant differences may exist, however, and must be considered in individual patients.     

Two dimensional and Doppler echocardiographic evaluation of double chambered right ventricle.

Two-dimensional and Doppler echocardiographic findings in 20 patients with double chambered right ventricle are described. All patients had the diagnosis established by cardiac catheterisation and confirmed at operation. Echocardiographic evaluation was done prior to surgical correction. Anomalous muscle bands in right ventricular cavity were detected in 16 patients. Doppler flow velocities in the right ventricular cavity suggested infundibular obstruction to blood flow at a low level in all 17 patients studied by Doppler echocardiography. Ventricular septal defects (11 patients), pulmonary stenosis (3 patients), and aortic regurgitation (3 patients) were detected accurately before operation by echocardiographic examination. Failure to detect the anomalous muscles in right ventricular cavity may occur in adult patients with poor anterior resolution and in those with severe right ventricular outflow obstruction and myocardial hypertrophy. Two dimensional echocardiography with Doppler flow analysis is useful in the evaluation and differential diagnosis of right ventricular outflow obstructions prior to invasive studies and surgical intervention.     

Noninvasive estimation of pulmonary artery diastolic pressure in patients with tricuspid regurgitation by Doppler echocardiography.

OBJECTIVES: The purpose of this study was to determine whether Doppler echocardiographic assessment of right ventricular pressure at the time of pulmonary valve opening could predict pulmonary artery diastolic pressure. BACKGROUND: Doppler echocardiography has been used to estimate right ventricular systolic pressure noninvasively. Because right ventricular and pulmonary artery diastolic pressure are equal at the time of pulmonary valve opening, Doppler echocardiographic estimation of right ventricular pressure at this point might provide an estimate of pulmonary artery diastolic pressure. METHODS: We studied 31 patients who underwent right heart catheterization and had tricuspid regurgitation. Pulmonary flow velocity was recorded by pulsed wave Doppler echocardiography, and tricuspid regurgitant velocity was recorded by continuous wave Doppler echocardiography. The time of pulmonary valve opening was determined as the onset of systolic flow in the pulmonary artery. Tricuspid velocity at the time of pulmonary valve opening was measured by superimposing the interval between the onset of the QRS complex on the ECG and the onset of pulmonary flow on the tricuspid regurgitant envelope. The tricuspid gradient at this instant was calculated from the measured tricuspid velocity using the Bernoulli equation. This gradient was compared to the pulmonary artery diastolic pressure obtained by right heart catheterization. MEASUREMENTS AND RESULTS: The pressure gradient between the right atrium and right ventricle obtained at the time of pulmonary valve opening ranged from 9 to 31 mm Hg (mean, 19+/-5) and correlated closely with invasively measured pulmonary artery diastolic pressure (range, 9 to 36 mm Hg; mean, 21+/-7 mm Hg; r = 0.92; SEE, 1.9 mm Hg). CONCLUSION: Doppler echocardiographic measurement of right ventricular pressure at the time of pulmonary valve opening is a reliable noninvasive method for estimating pulmonary diastolic pressure.     

Two-dimensional and color Doppler assessment of ventricular septal defect of congenital origin

Two-dimensional echocardiography and color Doppler examinations were performed in 53 patients with 58 ventricular septal defects (VSD) proven surgically or anatomically. All patients also had angiocardiograms. Two-dimensional echocardiography/color Doppler examination detected all VSDs and correctly categorized the site and extension of VSDs in 50 of 58 (86%). All 40 perimembranous VSDs were diagnosed in the left ventricular outflow tract short-axis plane as an area of discontinuity adjacent to septal tricuspid valve leaflet attachment. Fourteen of 16 VSDs with inlet extension showed initial color flow signals along the septal tricuspid leaflet and along the ventricular septum. Of 23 perimembranous VSDs with outlet extension, 19 had flow signals moving directly toward the right ventricular outflow tract. One perimembranous VSD with trabecular extension showed flow signals directed anterolaterally toward the right ventricular free wall. Eleven of 13 muscular VSDs were similarly categorized correctly by color Doppler as inlet, outlet and trabecular. All 5 doubly committed VSDs were correctly diagnosed as an area of discontinuity adjacent to the pulmonary valve in the short-axis view with flow signals directly moving through VSD into right ventricular outflow and pulmonary artery. Angiography correctly detected all VSDs and correctly classified their site and extension in 45 of 58 (77.5%). It misclassified 8 of 40 perimembranous, 3 of 13 muscular and 2 of 5 doubly committed VSDs. Color Doppler compares favorably with angiocardiography in the detection and localization of VSDs.     

Premature opening of the pulmonary valve in endomyocardial fibrosis

Two-dimensional and Doppler echocardiographic findings in a 67-year-old man with endomyocardial fibrosis (EMF) are described. The two-dimensional echocardiogram showed typical features of EMF, right ventricular endomyocardial calcification, a thickened right ventricular wall, obliteration of the apex of the right ventricle and marked dilatation of the right atrium. In addition, premature opening of the pulmonary valve was observed during late diastole. The Doppler echocardiogram revealed forward flow from the right ventricle to the pulmonary artery, indicating the conduit state of the right ventricle. These findings were supported by cardiac catheterization and autopsy. Thus, two-dimensional and Doppler echocardiography are useful not only in making the diagnosis, but also in understanding the hemodynamic condition in EMF.     

Cross sectional Doppler echocardiography as the initial technique for the diagnosis of acute pulmonary embolism.

OBJECTIVE--To determine the value of cross sectional Doppler echocardiography and derived indices of right ventricular pressure and function in the initial diagnosis of pulmonary embolism. BACKGROUND--Most deaths from acute pulmonary embolism occur because of a delay in diagnosis. Ventilation-perfusion scans are not sufficiently sensitive, whereas angiography is invasive and associated with complications. The use of cross sectional Doppler echocardiography to assess acute changes in right ventricular filling pressure and function, and in pulmonary arterial systolic pressure and its relation to embolism has not been studied in a large population. METHODS--60 consecutive patients with acute symptoms or haemodynamic instability suggestive of pulmonary embolism were studied. Confirmatory investigations included a ventilation-perfusion scan (36 patients), angiography (18 patients), surgery (5 patients), or necropsy (5 patients). RESULTS--There was evidence of right ventricular pressure or volume overload in all. This took the form of increased right ventricular end diastolic diameter and leftward bulging of the interventricular septum in diastole (56 patients); tricuspid valve regurgitation (56 patients) with the peak velocity of the regurgitant jet > 2.6 m/s; and a low collapse index for the inferior vena cava of < 40%, indicating raised mean right atrial pressure (in 49 patients). Intracardiac or pulmonary thrombi were visualised in 10 patients. In 14 patients treatment was undertaken on the basis of the echocardiographic signs alone. Four of them (with visible thrombi) recovered: the other 10 died. Lung emboli were demonstrated in 4 of 5 patients in whom necropsy was performed. CONCLUSIONS--Cross sectional Doppler echocardiography is a sensitive technique for the rapid identification of right ventricular overload in acute pulmonary embolism. It enables further investigations on treatment to be appropriately directed without delay. Resolution of emboli can also be assessed by serial measurement of the described indices.     

先心病患者脉冲多普勒肺动脉血流频谱时间间期的影响因素分析

对２８例先心病患者进行了脉冲多普勒超声心动图，右心导管及右室造影检查，探讨了影响脉冲多普勒肺动脉血流频谱时间间期的因素．结果表明，右室射血前期．加速时间，加速时间／右室射血前期及加速时间／右室射血期主要受右室后负荷的影响；右室射血期受右室后负荷及每搏量影响；右室射血前期／右室射血期不仅受右室后负荷影响，而且受右室收缩功能状态的影响．     

Isolated right ventricular dysfunction in systemic sclerosis: latent pulmonary hypertension?

Right ventricular function is frequently abnormal in patients with systemic sclerosis, but whether this is related to pulmonary vascular complications of the disease is unclear. Standard echocardiography with tissue Doppler imaging was performed at rest and during exercise for the study of right ventricular function and pulmonary circulation in 25 consecutive systemic sclerosis patients and in 13 age-matched healthy controls. When compared with the controls, the patients had no difference in systolic right ventricular pressure gradient, but a decreased pulmonary flow acceleration time, and increased right ventricular free wall thickness and end-diastolic dimensions. At the tricuspid annulus, the E maximal velocity was decreased (8.9 +/- 4 versus 11.7 +/- 2.3 cm.s(-1)) and the isovolumic relaxation time corrected to RR interval was increased (6.5 +/- 2.9 versus 4.5 +/- 2.5%). The tissue Doppler imaging profile at the mitral annulus was similar in both groups. At exercise, 18 patients had a decreased maximum workload and cardiac output, no change in systolic right ventricular pressure gradient, but an increase in the slope of pulmonary artery pressure/flow relationships. These results suggest that patients with systemic sclerosis may present with latent pulmonary hypertension as a likely cause of right ventricular diastolic dysfunction, as revealed by stress echocardiography and tissue Doppler imaging.     

Pulsed doppler echocardiographic detection of right-sided valve regurgitation: Experimental results and clinical significance

Pulsed Doppler echocardiography may allow noninvasive detection of tricuspid insufficiency as disturbed or turbulent systolic flow in the right atrium and pulmonary insufficiency as turbulent diastolic flow in the right ventricular outflow tract. Accordingly, six open chest mongrel dogs were examined with Doppler echocardiography before and after surgical creation of tricuspid and pulmonary insufficiency. The Doppler technique detected the appropriate lesion in all instances, with a specificity of 100 percent.In 121 patients (20 without heart disease, 101 with heart disease of various causes), pulsed Doppler echocardiography was used to detect right-sided valve regurgitation. Results were compared with right-sided pressure measurements and M mode echocardiographic findings in all, and with right ventricular angiography in 21 patients. Pulsed Doppler study detected tricuspid insufficiency in 61 of 100 patients, 12 (20 percent) of whom had clinical evidence of this lesion. Angiographic evidence of tricuspid regurgitation was present in 18 patients, 17 of whom had positive Doppler findings (sensitivity 94 percent), and absent in 3, all with negative Doppler findings. Pulmonary insufficiency was found on pulsed Doppler study in 47 of 91 patients, 3 of whom (all after pulmonary valvotomy) had clinical evidence of this lesion. Increased right ventricular systolic pressure (greater than 35 mm Hg) was noted more often in patients with (55 of 61 or 90 percent) than in those without (22 of 59 or 37 percent) tricuspid insufficiency (p <0.01). Pulmonary arterial mean pressure was elevated (22 mm Hg or less) more often in patients with (38 of 43 or 88 percent) than in those without (24 of 64 or 38 percent) pulmonary insufficiency (p <0.01).Thus, pulsed Doppler echocardiography appears to be an accurate noninvasive technique for detection of right-sided valve regurgitation. The absence of diagnostic physical findings in many of the patients indicates that the hemodynamic severity of the Doppler-detected valve insufficiency was probably insignificant. However, because of its high incidence rate (87 percent) and association with pulmonary hypertension (87 percent), pulsed Doppler detection of tricuspid or pulmonary insufficiency, or both (in the absence of pulmonary stenosis) was found superior to M mode echocardiographic measurements (right ventricular size, pulmonary valve motion) in the prediction of pulmonary hypertension.     

Doppler echocardiographic evaluation of pulmonary artery pressure in chronic obstructive pulmonary disease. A European multicentre study. Working Group on Noninvasive Evaluation of Pulmonary Artery Pressure. European Office of the World Health Organization, Copenhagen

The feasibility, reproducibility and reliability of Doppler echocardiography in evaluation of pulmonary artery pressure in patients with chronic obstructive pulmonary disease (COPD) were determined in a multicentre study. In 100 COPD patients with mean pulmonary artery pressure ranging from 10 to 62 mmHg at cardiac catheterization, pulmonary pressure estimation was attempted by four Doppler echocardiographic methods. These methods comprised the calculation of transtricuspid and transpulmonary pressure gradients from Doppler-detected tricuspid or pulmonary regurgitation, the evaluation of right ventricular outflow tract velocity profiles with the measurement of right ventricular systolic time intervals and the measurement of the right ventricular isovolumic relaxation time. In 98 (98%) patients at least one of the methods could be employed. A tricuspid regurgitation jet was detected in 47 (47%) patients but its quality was adequate for measurement in 30 (30%). Pulmonary regurgitation jet velocity was measured only in five cases. The standard error of estimate in testing intra- and interobserver reproducibility of Doppler systolic time intervals was less than 5%. The predictive value of right ventricular outflow tract acceleration time less than 90 ms in the identification of patients with mean pulmonary artery pressure greater than 20 mmHg was 80%. Of Doppler echocardiographic data, best correlations with mean pulmonary artery pressure were found for the transtricupid gradient (r = 0.73, SEE = 7.4 mmHg), for the right ventricular acceleration time (r = 0.65, SEE = 8 mmHg) and right ventricular isovolumic relaxation time (r = 0.61, SEE = 8.5 mmHg).(ABSTRACT TRUNCATED AT 250 WORDS)     

Role of two-dimensional echocardiography, pulsed, continuous wave color flow Doppler techniques in the assessment of ventricular septal rupture after myocardial infarction

Two-dimensional echocardiography, pulsed and continuous wave Doppler techniques were used for the evaluation of 15 consecutive patients (9 men, 6 women; mean age 71 years, range 61 to 79) with ventricular septal rupture due to acute myocardial infarction (7 anterior, 8 posterior). Standard and modified off-axis 2-dimensional echocardiographic views from parasternal, apical and subcostal windows correctly identified this defect in 14 of the 15 patients. Pulsed Doppler echocardiography confirmed the presence of left-to-right-sided shunt by showing a high-velocity, aliased, systolic flow and a low-velocity diastolic flow in the right ventricle in 14 patients. Continuous wave Doppler echocardiography showed a high-velocity systolic and low-velocity diastolic flow signal of left-to-right shunt in 14 patients. Color flow Doppler imaging identified a left-to-right shunt in all 6 patients in whom it was performed. Doppler and 2-dimensional echocardiographic studies missed a small apical septal defect in 1 patient with anteroseptal myocardial infarction. Two-dimensional echocardiography correctly diagnosed right ventricular infarction in all 5 patients with posteroinferior infarction. Ventricular septal rupture and/or left-to-right-sided shunt was confirmed in all 15 patients by the following: surgical inspection in 11, necropsy in 3, left ventricular cineangiography in 5 and right-sided heart catheterization and oximetry data in 13 patients. Data indicate that 2-dimensional echocardiography correctly shows the precise location of septal rupture in most patients after acute myocardial infarction and allows assessment of left and right ventricular infarction and function.(ABSTRACT TRUNCATED AT 250 WORDS)     

Central and pulmonary hemodynamics in patients with various forms of ischemic heart disease]

Two-dimensional and Doppler echocardiographies were used to examine right cardiac and pulmonary hemodynamics in patients with various types of coronary heart disease (CHD). All the patients were divided into 3 morphofunctional groups of CHD according to the left ventricular volume/mass index. They all were found to exhibit decreased left cardiac contractility and pump function, parallel with moderately elevated pulmonary pressure and right cardiac compensatory hyperfunction, which was largely evident in hypertrophic morphofunctional CHD. The degree of pulmonary hypertension was related to the severity of left ventricular pump dysfunction, but to its disturbed contractility in the dilated type.     

Echocardiographic pulsed doppler features of absent pulmonary valve syndrome in the neonate

M mode echocardiography was used to evaluate nine neonates with absent pulmonary valve syndrome. Six were also studied with two dimensional echocardiography and two with pulsed Doppler echocardiography. M mode echocardiography demonstrated a large, overriding great artery and right ventricular dilation in all nine patients and abnormal septal motion in eight. Two dimensional echocardiography demonstrated aneurysmal dilation of the main pulmonary artery in all six patients studied. Pulsed Doppler echocardiography in the two infants studied demonstrated anterograde systolic and retrograde diastolic flow in the main pulmonary artery and right ventricular outflow tract. The echocardiographic features of absent pulmonary valve syndrome appear to be unique and allow the diagnosis to be made noninvasively, thus obviating or delaying the need for potentially high risk cardiac catheterization.     

Feasibility of generating hemodynamic pressure curves from noninvasive Doppler echocardiographic signals

Objectives. This study was designed to determine the feasibility of Doppler generation of accurate, complete right ventricular and pulmonary artery pressure curves in patients with Dopplermeasurable tricuspid and pulmonary regurgitation.Background. Doppler-derived flow velocities have been used to assess right ventricular systolic pressure; pulmonary artery systolic, diastolic and mean pressures, and left ventricular systolic and diastolic pressures. Instantaneous gradient across any area of discrete narrowing is accurately derived using the simplified Bernoulli equation (4V²). Invasive catheterization is currently the only means of generating intracardiac pressure curves. Noninvasively derived pressure curves using Doppler echocardiography would be a considerable advance in the assessment of normal and pathologic cardiac hemodynamics.Methods. Right ventricular and pulmonary artery pressure curves were generated in 18 of 22 patients with measurable tricuspid and pulmonary valve regurgitation using superimposition of Doppler-measured tricuspid and pulmonary valve blood flow velocities on an assumed right atrial pressure. Dopplermeasured right ventricular and pulmonary artery pressure curves were compared with simultaneous catheterization-measured curves.Results. Doppler-derived pulmonary artery systolic pressure (Doppler PAP) correlated with simultaneous catheter-measured pulmonary artery pressure (Cath PAP) by the equation Doppler PAP = 0.92(Cath PAP) + 4.5, r = 0.98. Other Doppler-derived pressure measurements that correlated at near identity with the catheterization-measured corresponding measurement include Doppler-derived pulmonary artery mean pressure (Doppler mean PAP) [Doppler mean PAP = 0.85(Cath mean PAP) + 2.6, r = 0.97], and Doppler-derived right ventricular pressure (Doppler RVP) [Doppler RVP = 0.84(Cath measured RVP) + 7.9, r = 0.98]. Doppler-derived pulmonary artery diastolic pressure (Doppler PAP diast) did not correspond as well in this study [Doppler PAP diast = 0.45(Cath PAP diast) + 6.6, r = 0.83].Conclusions. Clinically usable right ventricular and pulmonary artery pressure curves can be derived by superimposing Dopplermeasured tricuspid and pulmonary valve blood flow velocities in patients with tricuspid and pulmonary valve regurgitation.     

Accuracy of combined two-dimensional echocardiography and continuous wave Doppler recordings in the estimation of pressure gradient in right ventricular outlet obstruction

Fifteen patients (median age 8.5 years) with fixed right ventricular outflow tract obstruction were evaluated by two-dimensional echocardiographically directed continuous wave Doppler ultrasound within 24 hours of cardiac catheterization. Pulmonary artery blood velocity measurements were determined from a real time spectral display of pulmonary artery flow profile and converted to pressure drop utilizing a modified Bernoulli equation. Use of both parasternal and subcostal imaging permitted more accurate detection of maximal flow velocity than did use of either approach alone. Gradients estimated from Doppler recordings correlated well with those measured at cardiac catheterization (correlation coefficient = 0.95, standard error of the estimate = 7.9 mm Hg) with a trend to slight underestimation of gradient in more severe obstruction. In three patients with combined valvular and subvalvular stenosis and one patient with right ventricular outlet obstruction due totally to a ventricular septal aneurysm, Doppler estimation of gradient provided an accurate assessment of total right ventricular-pulmonary artery gradient. Thus, continuous wave Doppler ultrasound combined with two-dimensional echocardiography provides a reliable noninvasive method of estimating pressure gradient in patients with right ventricular outflow tract obstruction.     

Pulsed Doppler echocardiography in the diagnosis of pulmonary hypertension in COPD

We used pulsed Doppler echocardiography to examine the systolic ejection flow from the right ventricle in 66 patients with chronic obstructive pulmonary disease. Adequate recordings were obtained in 60 patients, in conjunction with right heart catheterization. Patients without pulmonary artery hypertension at rest (mean pulmonary artery pressure less than 20 mm Hg) underwent an exercise test which identified a group with PAH during exercise (MPAP greater than 30 mm Hg). The patients were divided into four groups: group 1, or control group: 17 healthy nonsmokers without normal respiratory function data; group 2: COPD without PAH (n = 12); group 3: PAH during exercise (n = 26); group 4: PAH at rest (n = 22). Analysis of Doppler data included time to peak velocity, right ventricular pre-ejection period, and ejection period. Pulsed Doppler echocardiography was a simple and reliable method of detecting PAH. Latent PAH, revealed by the exercise test, was accompanied by significant changes in Doppler findings, confirming the sensitivity of the method.     

Role of echocardiography in acute pulmonary embolism

The difficulty in making an accurate diagnosis of acute pulmonary embolism is well known. To clarify the role of echocardiography, including Doppler echocardiography, in acute pulmonary embolism, we examined hemodynamic and echocardiographic parameters in 9 patients with acute pulmonary embolism just before and after treatment with urokinase. As hemodynamic parameters normalized after treatment, echocardiographic parameters such as deformity index of the left ventricle (LV-DI), end-diastolic dimension of the right ventricle (RVDd), the left ventricle (LVDd), the inferior vena cava, and RVDd/LVDd all significantly changed toward normal. Highly significant correlations were found between the echocardiographic and hemodynamic parameters, the best of which was between the LV-DI and systolic pulmonary artery pressure (r = -0.885, p less than 0.001). Doppler echocardiography quantitatively evaluated the grade of tricuspid regurgitation, and accurately estimated systolic pulmonary artery pressure. We conclude that echocardiography, including Doppler echocardiography, sensitively reflects the right ventricular pressure and volume overload of acute pulmonary embolism, is quite useful for its diagnosis which is often difficult, and is suitable for noninvasive follow up of these patients.