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Mori A, Uchida N, Ishiguro Y, Atsuko T, Kanako M, Mikio M. Evaluation of cardiac function of the fetus by inferior vena cava diameter pulse waveform. Am Heart J 2007; 154:789-94. [PMID: 17893010 DOI: 10.1016/j.ahj.2007.06.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2007] [Accepted: 06/17/2007] [Indexed: 12/01/2022]
Abstract
BACKGROUND The diameter pulse waveforms (DPWs) are known to reflect the pressure waveforms at the target vessel. Our purpose was to clarify the usefulness of DPWs recorded noninvasively from the fetal inferior vena cava (IVC) for detecting cardiac function. METHODS A paired ultrasonic phase-locked echo tracking system was used to follow the movement of diametrically opposite points of the IVC. RESULTS We studied 90 healthy fetuses (20-40 weeks, normal group) and 21 fetuses with cardiac abnormalities. The 4 component (A, X, V, and Y) waves of the DPW were identified. In the normal group, there was an increase in the depth of X and Y descents with advancing gestation. The 21 fetuses with suspected cardiac dysfunction were divided into normal and cardiac dysfunction subgroups, according to the values of fractional shortening and preload index. Of these, 11 fetuses with cardiac dysfunction had significantly higher incidence of shallow X nadir (P < .001) than the remaining 10 fetuses with normal cardiac function. CONCLUSION The DPW analysis in the fetal IVC proved useful for detecting fetal cardiac dysfunction in utero.
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Affiliation(s)
- Akira Mori
- Maternal and Perinatal Centore, Tokai University School of Medicine, Boseidai, Isehara-city, Kanagawa, Japan.
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2
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Hinderliter AL, Willis PW, Long WA, Clarke WR, Ralph D, Caldwell EJ, Williams W, Ettinger NA, Hill NS, Summer WR, de Boisblanc B, Koch G, Li S, Clayton LM, Jöbsis MM, Crow JW. Frequency and severity of tricuspid regurgitation determined by Doppler echocardiography in primary pulmonary hypertension. Am J Cardiol 2003; 91:1033-7, A9. [PMID: 12686360 DOI: 10.1016/s0002-9149(03)00136-x] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Alan L Hinderliter
- Department of Medicine, University of North Carolina, CB 7075, Chapel Hill, NC 27599, USA.
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3
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Fujita Y, Satoh S, Koga T, Mori A, Nakano H. Aortic pulse waveforms for evaluating cardiac performance in the human fetus. ULTRASOUND IN MEDICINE & BIOLOGY 2002; 28:1245-1250. [PMID: 12467850 DOI: 10.1016/s0301-5629(02)00609-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Pulse waveforms of the fetal descending aorta were obtained using an echo-tracking system to clarify the gestational age-related changes and the usefulness for detecting cardiac dysfunction. Peak systolic (PSD) and end diastolic diameter (EDD), pulse amplitude (Amp) and Amp:EDD ratio, calculated from the pulse waveforms, were adopted for analysis. In 196 normal fetuses after 20 weeks, the PSD, EDD and Amp increased, and Amp:EDD ratio decreased linearly with advancing gestation. The 19 fetuses with suspected cardiac dysfunction were divided into healthy and altered cardiac function subgroups, according to the values of fractional shortening and preload index. Of these, 7 fetuses with cardiac dysfunction had significantly higher incidence of low Amp (p < 0.01) and Amp:EDD ratio (p < 0.001) than remaining 12 fetuses with normal cardiac function. The pulse waveform analysis in the fetal descending aorta proved useful for detecting fetal cardiac dysfunction in utero.
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Affiliation(s)
- Yasuyuki Fujita
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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4
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Tribouilloy CM, Enriquez-Sarano M, Capps MA, Bailey KR, Tajik AJ. Contrasting effect of similar effective regurgitant orifice area in mitral and tricuspid regurgitation: a quantitative Doppler echocardiographic study. J Am Soc Echocardiogr 2002; 15:958-65. [PMID: 12221413 DOI: 10.1067/mje.2002.117538] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We compared the effect of similar effective regurgitant orifice (ERO) areas in tricuspid regurgitation (TR) and mitral regurgitation (MR) on hemodynamics and volume overload, and examined the impact on grading of TR and MR severity. In a prospective study, 95 patients with TR in sinus rhythm were compared with 95 patients with MR in sinus rhythm matched for ERO area, age, and body surface area. We found that similar ERO area was associated with decreased volume overload in TR compared with MR. There were more women with TR than with MR, but comparison stratified by sex confirmed that regurgitant volume (RVol) was smaller in TR than in MR for similar ERO area. However, patients with systolic venous flow reversal (hepatic for TR and pulmonary for MR) had lower RVol but similar ERO area in TR compared with MR. Therefore, optimal diagnostic thresholds for severe regurgitation (maximum sum of sensitivity and specificity) in TR and MR were different for RVol (45 and 60 mL/beat, respectively) but similar for ERO area (40 mm(2)). We conclude that similar ERO areas induce less RVol in TR than in MR because of the decreased driving force in TR, but have similar consequences with regard to venous flow reversal. Therefore, a similar ERO area grading scheme can be used, and an ERO area of 40 mm(2) or greater is consistent with severe regurgitation in both TR and MR.
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Affiliation(s)
- Christophe M Tribouilloy
- Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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5
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Tribouilloy CM, Enriquez-Sarano M, Bailey KR, Tajik AJ, Seward JB. Quantification of tricuspid regurgitation by measuring the width of the vena contracta with Doppler color flow imaging: a clinical study. J Am Coll Cardiol 2000; 36:472-8. [PMID: 10933360 DOI: 10.1016/s0735-1097(00)00762-2] [Citation(s) in RCA: 128] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We sought to evaluate the vena contracta width (VCW) measured using color Doppler as an index of severity of tricuspid regurgitation (TR). BACKGROUND The VCW is a reliable measure of mitral and aortic regurgitation, but its value in measuring TR is uncertain. METHODS In 71 consecutive patients with TR, the VCW was prospectively measured using color Doppler and compared with the results of the flow convergence method and hepatic venous flow, and its diagnostic value for severe TR was assessed. RESULTS The VCW was 6.1+/-3.4 mm and was significantly higher in patients with, than those without, severe TR (9.6+/-2.9 vs. 4.2 +/- 1.6 mm, p<0.0001). The VCW correlated well with the effective regurgitant orifice (ERO) by the flow convergence method (r = 0.90, SEE = 0.17 cm2, p<0.0001), even when restricted to patients with eccentric jets (r = 0.93, p < 0.0001). The VCW also showed significant correlations with hepatic venous flow (r = 0.79, p < 0.0001), regurgitant volume (r = 0.77, p<0.0001) and right atrial area (r = 0.46, p< 0.0001). A VCW > or =6.5 mm identified severe TR with 88.5% sensitivity and 93.3% specificity. In comparison with jet area or jet/right atrial area ratio, the VCW showed better correlations with ERO (both p<0.01) and a larger area under the receiver operating characteristic curve (0.98 vs. 0.88 and 0.85, both p<0.02) for the diagnosis of severe TR. CONCLUSIONS The VCW measured by color Doppler correlates closely with severity of TR. This quantitative method is simple, provides a high diagnostic value (superior to that of jet size) for severe TR and represents a useful tool for comprehensive, noninvasive quantitation of TR.
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Affiliation(s)
- C M Tribouilloy
- Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA
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6
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Bajzer CT, Stewart WJ, Cosgrove DM, Azzam SJ, Arheart KL, Klein AL. Tricuspid valve surgery and intraoperative echocardiography: factors affecting survival, clinical outcome, and echocardiographic success. J Am Coll Cardiol 1998; 32:1023-31. [PMID: 9768728 DOI: 10.1016/s0735-1097(98)00355-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The impact of echocardiographic-guided treatment on outcome after tricuspid valve (TV) surgery is not well defined. OBJECTIVES The purpose of this study was to determine clinical and echocardiographic factors associated with adverse outcomes after TV surgery and determine the role of intraoperative echo (IOE) in facilitating successful outcomes after TV surgery. METHODS Four hundred and one patients (279 females, mean age 60 years) underwent TV surgery and other concomitant cardiac surgery at a single institution and were followed clinically and by echocardiography during a 10-year period. RESULTS Decreased survival after TV surgery was associated with: preoperative increased New York Heart Association (NYHA) functional classification (relative risk [RR]=2.02), increased left ventricular dysfunction by echocardiography (RR=1.28), and use of a TV replacement strategy (RR=2.92). Decreased event-free survival after TV surgery was associated with concomitant coronary artery bypass grafting (RR=2.97). Late echocardiographic failure (3 to 4+ tricuspid valve regurgitation [TR]) after TV surgery was associated with increased severity of TR on preoperative echocardiogram (odds ratio [OR]=1.91). Decreased late echocardiographic failure after TV surgery was associated with the use of a TV annuloplasty ring with a repair strategy (OR=0.40). The surgical plan was altered at the time of surgery to insure a successful outcome in 32 (10%) of 335 patients based on IOE findings. CONCLUSIONS Adverse outcomes after TV surgery can be predicted by several preoperative clinical and echocardiographic variables. IOE is useful in improving immediate, but not late, outcomes after TV surgery.
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Affiliation(s)
- C T Bajzer
- Department of Cardiology, The Cleveland Clinic Foundation, Ohio 44106-0001, USA
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Shapira Y, Porter A, Wurzel M, Vaturi M, Sagie A. Evaluation of tricuspid regurgitation severity: echocardiographic and clinical correlation. J Am Soc Echocardiogr 1998; 11:652-9. [PMID: 9657405 DOI: 10.1016/s0894-7317(98)70042-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The correlation between 19 echocardiographic markers of tricuspid regurgitation (TR) severity and findings on physical examination was studied in 66 consecutive patients (age 63 +/- 12 years) with moderate or severe TR. Clinical TR was defined by two or more of the following: prominent jugular venous pulse V waves, pulsating liver, and sea-saw parasternal movement. Thirty-eight patients (57.6%) had clinical TR, whereas 28 patients (42.4%) did not. In a univariate analysis, the most powerful predictors of clinical TR (p < 0.01) were jet area > or =9 cm2, right atrial area > or =30 cm2, jet width at origin > or =0.8 cm, systolic flow reversal in the hepatic veins, paradoxical septal movement, diastolic septal flattening, inferior vena cava diameter > or =2.1 cm, and lack of inferior vena cava respiratory variation. Regurgitant index was a weaker predictor. Multivariate analysis showed that the only independent echocardiographic predictor of clinical TR was systolic flow reversal (positive and negative predictive values 91.2% and 78.1%, respectively). Significant echocardiographic TR can be subclinical in a substantial number of patients.
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Affiliation(s)
- Y Shapira
- Sheingarten Echocardiography Unit, Rabin Medical Center, Petah-Tiqva, Israel
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8
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Grimes RY, Nyarko SJ, Pulido GA, Yang S, Walker PG, Levine RA, Yoganathan AP. Atrial inflow can alter regurgitant jet size: in vitro studies. ULTRASOUND IN MEDICINE & BIOLOGY 1995; 21:459-469. [PMID: 7571139 DOI: 10.1016/0301-5629(94)00138-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Recent studies have attempted to predict the severity of regurgitant lesions from color Doppler jet size, which is a function of orifice momentum for free jets. Jets of mitral and tricuspid regurgitation, however, are opposed by flows entering the atria. Despite their low velocities, these counterflows may have considerable momentum that can limit jet penetration. The purpose of this study was to address the hypothesis that such counterflow fields influence regurgitant jet size. Steady flow was driven through 2.4- and 5.1-mm-diameter circular orifices at 2 to 6 m/s. At a constant orifice velocity and flow rate, the velocity of a uniform counterflow field was varied from 5 to 30 cm/s. Jet dimensions were measured by both fluorescent dye visualization and Doppler color flow mapping. The results showed that despite its relatively low velocities, counterflow dramatically curtailed jet length and area. Jet dimensions were functions of the ratio of jet to counterflow momentum. Thus, atrial inflow may participate in determining jet size and can alter the relation between jet size and lesion severity in mitral and tricuspid regurgitation.
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Affiliation(s)
- R Y Grimes
- Cardiovascular Fluid Mechanics Laboratory, Schools of Mechanical/Chemical Engineering, Georgia Institute of Technology, Atlanta 30332-0100, USA
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9
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Arisawa J, Morimoto S, Ikezoe J, Naitoh H, Yamagami H, Kozuka T, Sano T, Shimazaki Y, Matsuda H. Pulsed Doppler echocardiographic assessment of portal venous flow patterns in patients after the Fontan operation. Heart 1993; 69:41-6. [PMID: 8457393 PMCID: PMC1024915 DOI: 10.1136/hrt.69.1.41] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVE To assess the effect of the condition of the right heart after the Fontan operation on portal venous flow, and to determine whether the characteristics of portal venous flow were different when there was an atriopulmonary connection with atrial septal closure rather than an atriopulmonary or total cavopulmonary connection with intra-atrial routing. PATIENTS AND METHODS After the Fontan operation six patients with an atriopulmonary connection (group 1), three patients with an atriosubpulmonary connection (group 2), four patients with intra-atrial routing and an atriopulmonary connection (group 3), and five patients with a total cavopulmonary connection (group 4) were studied by pulsed Doppler echocardiography. The flow signals were recorded for the pulmonary artery, hepatic vein, and intrahepatic portal vein in each patient. Postoperative cardiac catheterisation was performed in 16 of the 18 patients. The Doppler findings were compared with those of 14 controls. RESULTS The portal flow was pulsatile in 13 patients and constant in five patients. Reversed flow was shown at or just after the QRS wave after hepatic venous regurgitation in two group 1 patients. The flow signal was interrupted in two group 1 patients and two group 2 patients. Decrease in velocity of flow was recorded in two group 1 patients, one group 2 patients, three group 3 patients, and one group 4 patient. Portal flow was constant in one group 3 patient and four group 4 patients. The pulsatility ratio ranged from -0.46 to 0.49 (mean (SD), 0.03 (0.32)) in the patients from group 1 and 2, from 0.41 to 0.76 (0.54 (0.15)) in group 3, and from 0.70 to 0.80 (0.75 (0.04)) in group 4. The ratio in the controls ranged from 0.29 to 0.83 (0.61 (0.13)). The ratio was significantly lower in groups 1 and 2 than in group 3 (p < 0.01), group 4 (p < 0.01), or the controls (p < 0.005). There was no significant difference in the ratio between group 3 and group 4 and no correlation between the pulsatility ratio and the cardiac index (r = 0.26), mean right atrial pressure (r = 0.25), or pulmonary vascular resistance (r = 0.17). CONCLUSION The larger hepatic venous regurgitation caused by atrial contraction in patients with an atriopulmonary connection correlated with the higher portal pulsatility and a total cavopulmonary connection reduced portal pulsatility.
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Affiliation(s)
- J Arisawa
- Department of Radiology, Osaka University Medical School, Japan
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10
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Affiliation(s)
- W Kincaid
- Department of Diagnostic Radiology, Western Infirmary, Glasgow, UK
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11
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Kishimoto R, Choji K, Massoud TF, Matsuoka S, Chen M, Fujita N, Irie G. Segmental reversal of intrahepatic portal flow due to a liver metastasis. Br J Radiol 1992; 65:1035-8. [PMID: 1450819 DOI: 10.1259/0007-1285-65-779-1035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- R Kishimoto
- Department of Radiology, Hokkaido University School of Medicine, Sapporo, Japan
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12
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Gembruch U, Knöpfle G, Chatterjee M, Bald R, Redel DA, Födisch HJ, Hansmann M. Prenatal diagnosis of atrioventricular canal malformations with up-to-date echocardiographic technology: report of 14 cases. Am Heart J 1991; 121:1489-97. [PMID: 2017980 DOI: 10.1016/0002-8703(91)90156-c] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Fourteen fetuses with atrioventricular canal malformations were examined by two-dimensional echocardiography, pulsed-wave Doppler echocardiography, and color Doppler flow mapping. Eleven fetuses had complete and three fetuses had partial atrioventricular canal malformations. Nonimmune hydrops fetalis was associated with six cases, and fetal arrhythmia was seen in three cases. With two-dimensional echocardiography, the atrioventricular canal malformations could be diagnosed accurately. The inclusion of color Doppler flow mapping, however, provided additional hemodynamic information that was important from the prognostic point of view. Incompetence of atrioventricular valves could be demonstrated in 10 of 14 cases by Doppler echocardiography. In nine cases, detailed Doppler echocardiographic evaluation of the regurgitation jet was possible. The proportion of systolic time during which atrioventricular valve insufficiency was demonstrated was related to the occurrence of nonimmune hydrops fetalis. When insufficiency of atrioventricular valves was associated with hydrops (four cases), a pansystolic insufficiency was always present. In cases without hydrops (five), regurgitation was confined to early systole. Thus a reliable method for semiquantitative evaluation of the degree of insufficiency seems to have been found. Moreover, an association appeared to exist between the occurrence of hydrops fetalis and the proportion of atrial area that was taken up by regurgitant jet area, as determined by planimetry in the four-chamber view. Prenatal diagnosis was confirmed by autopsy or neonatal cardiac evaluation. Only one neonate survived in our series. Two were stillborn, four died during the neonatal period, two died during infancy, and pregnancy was electively terminated prematurely in five cases. Eight fetuses were found to have a karyotypic abnormality.
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Affiliation(s)
- U Gembruch
- Department of Prenatal Diagnosis and Therapy, University of Bonn, Germany
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14
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Laaban JP, Diebold B, Lafay M, Rochemaure J, Peronneau P. Detection of pulmonary hypertension by Doppler echocardiography of the inferior vena cava in chronic airflow obstruction. Thorax 1989; 44:396-401. [PMID: 2763238 PMCID: PMC461843 DOI: 10.1136/thx.44.5.396] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Pulsed Doppler echocardiography of the inferior vena cava is an accurate method for the diagnosis of tricuspid regurgitation and impaired right ventricular compliance, two features of pulmonary hypertension. The purpose of this study was to assess the value of Doppler echocardiography of the inferior vena cava for the detection of pulmonary arterial hypertension in patients with chronic obstructive lung disease. Pulse Doppler echocardiography of the inferior vena cava and right heart catheterisation were performed in 29 patients with severe chronic obstructive lung disease. The mean pulmonary arterial pressure was 27 (10) mm Hg for the entire group; 62% of patients (18/29) had pulmonary arterial hypertension (mean pulmonary arterial pressure greater than 20 mm Hg). An adequate Doppler signal could be obtained in 25 of the 29 patients (86%). Pulsed Doppler echocardiography of the inferior vena cava gave normal results in 10 patients and disclosed tricuspid regurgitation in seven patients, impaired right ventricular compliance in seven patients, and both of these abnormalities in one patient. An abnormal Doppler echocardiogram of the inferior vena cava (tricuspid regurgitation or impaired right ventricular compliance, or both) predicted the presence of pulmonary arterial hypertension with a sensitivity of 87% and a specificity of 80%. These results suggest that pulsed Doppler echocardiography of the inferior vena cava may be a useful though imperfect method of detecting pulmonary arterial hypertension in patients with chronic obstructive lung disease.
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Affiliation(s)
- J P Laaban
- Department of Pneumology and Intensive Care, Hôtel-Dieu, Paris, France
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15
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Carreras F, Borrás X, Augé JM, Pons-Lladó G. Pulsed Doppler assessment of tricuspid regurgitation: usefulness of regurgitant signal patterns for estimation of severity. Angiology 1988; 39:788-94. [PMID: 3421512 DOI: 10.1177/000331978803900902] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
A study on the value of pulsed Doppler in the detection and quantitative assessment of tricuspid regurgitation (TR) has been conducted on 33 consecutive adult patients with valvular heart disease. Only 1 patient had to be excluded owing to a technically inadequate Doppler examination. Data for comparison were obtained from a right heart catheterization performed within a twenty-four-hour interval from the Doppler study. Sensitivity and specificity in the detection of the lesion were 88% and 100%, respectively. A previously undescribed pulsed Doppler method for the estimation of the degree of TR was tested, based on the consideration of two distinctive patterns of the regurgitant Doppler signal: type I: a protosystolic regurgitant signal with progressively fading intensity along systole; and type II: a homogeneously intense pansystolic signal. Correlation between these patterns and the angiographic degrees of TR showed that milder lesions correspond to the type I Doppler pattern, whereas significant regurgitations present a type II pattern, this allowing a clinically useful method of assessment of TR.
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Affiliation(s)
- F Carreras
- Servei de Cardiologia, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Spain
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Martin GR, Silverman NH, Soifer SJ, Lutin WA, Scagnelli SA. Tricuspid regurgitation in children: a pulsed Doppler, contrast echocardiographic and angiographic comparison. J Am Soc Echocardiogr 1988; 1:257-63. [PMID: 3272773 DOI: 10.1016/s0894-7317(88)80041-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Thirty-one children with congenital heart disease were examined for tricuspid regurgitation by four methods: (1) auscultation, (2) pulsed Doppler echocardiography, (3) saline contrast echocardiography, and (4) right ventricular angiography. Tricuspid regurgitation was detected in three children by auscultation, in 20 by pulsed Doppler echocardiography, in 21 by saline contrast echocardiography, and in 20 by right ventricular angiography. To determine the prevalence of tricuspid regurgitation in children suspected of having congenital heart disease, we reviewed 5417 Doppler echocardiograms performed between 1983 and 1985. Tricuspid regurgitation was detected in 399 of 4670 children (8.5%) with congenital heart disease and in 26 of 106 newborns (25%) with respiratory distress. By comparison, tricuspid regurgitation was detected in only 19 of 641 (3%) normal children. Tricuspid regurgitation is uncommon in normal children, but its incidence in children with congenital heart disease and/or respiratory distress is high.
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Affiliation(s)
- G R Martin
- Department of Pediatrics, University of California, San Francisco 94143
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17
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Morgan DE, Norman R, West RO, Burggraf G. Echocardiographic assessment of tricuspid regurgitation during ventricular demand pacing. Am J Cardiol 1986; 58:1025-9. [PMID: 3776842 DOI: 10.1016/s0002-9149(86)80032-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Twenty patients from our pacemaker clinic population were assessed clinically and by saline contrast echocardiography (subxiphoid view) to determine the prevalence of tricuspid regurgitation (TR) and, if TR was present, its mechanism. The patients had no known TR before lead placement, a single transvenous right ventricular pacing lead present more than 6 months (mean 52, range 7 to 138), ventricular demand pacing alternating with sinus rhythm and rate programmability. Each patient was studied in sinus rhythm and during ventricular pacing. Using the criterion of inferior vena cava (IVC) contrast reflux during ventricular systole to diagnose TR, no patient had evidence of TR in sinus rhythm, consistent with clinical examination. During ventricular demand pacing, jugular venous pulse cannon A waves developed in 10 patients, and 18 patients (including these 10) had IVC contrast reflux during ventricular systole. Analysis of the timing of IVC reflux revealed its close temporal relation to the timing of atrial systole rather than a fixed timing during ventricular systole. This reflux occurred with loss of normal atrioventricular (AV) synchrony and the underlying mechanism in all cases was shown to be right atrial contraction against a closed tricuspid valve. Two patients who did not have such a pattern with pacing maintained normal AV synchrony. These observations indicate that: TR is an uncommon accompaniment of ventricular demand pacing; the jugular venous pulse and IVC echocardiographic contrast patterns during ventricular demand pacing simulate TR when AV asynchrony [corrected] occurs; and the IVC contrast pattern of pacing induced AV asynchrony [corrected] is best termed the cannon A wave synchronous pattern.
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Curtius JM, Thyssen M, Breuer HW, Loogen F. Doppler versus contrast echocardiography for diagnosis of tricuspid regurgitation. Am J Cardiol 1985; 56:333-6. [PMID: 4025174 DOI: 10.1016/0002-9149(85)90859-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Sixty-eight patients (mean age 49 years) were studied with contrast echocardiography (CE) and Doppler echocardiography (DE) to evaluate both methods for detecting and grading tricuspid regurgitation (TR). In all patients, right ventricular (RV) angiography was performed. The severity of TR was graded on a 4-point scale. Only 68 of 88 patients who underwent RV angiography (77%) could be evaluated, but 65 of 68 patients who underwent CE (96%) and all 68 who underwent DE (100%) could be evaluated. TR was present in 33 patients as seen on RV angiography. CE and DE correctly diagnosed 27 and 30 patients, respectively, corresponding to a sensitivity of 82% for CE and 91% for DE. Specificity was 100% for CE and 86% for DE. CE and DE grading, respectively, of TR vs RV angiographic grading showed no difference in 50 and 47 patients, a 1-level difference in 8 and 13 and a 2-level difference in 7 and 5 cases. (CE-RV angiography, r = 0.84, p less than 0.001; DE-RV angiography, r = 0.82, p less than 0.001). Thus, CE and DE are accurate methods for routine diagnosis of TR, with DE having higher sensitivity and easier grading. Considering the possibility of false-positive findings of our standard RV angiography, sensitivity and specificity of CE and DE could be even higher.
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