TY - JOUR
T1 - Pulsed doppler echocardiographic detection of right-sided valve regurgitation. Experimental results and clinical significance
AU - Waggoner, Alan D.
AU - Quiñones, Miguel A.
AU - Young, James B.
AU - Brandon, Tedd A.
AU - Shah, Abid A.
AU - Verani, Mario S.
AU - Miller, Richard R.
N1 - Funding Information:
From the Section of Cardiology, Department of Medicine, Baylor College of Medicine and The Methodist Hospital, Houston, Texas. This study was supported in part by Research Grant 450-GO-7740 from the American Heart Association, Texas Affiliate, Austin, Texas and the National Heart, Lung, and Blood Vessel Research and Demonstration Center, Baylor College of Medicine, Houston, Texas, Grant HL-17269 from the National Heart, Lung, and Blood Institutes, Bethesda, Maryland. Computational assistance was provided by the CLINFO Project, funded by Grant RR-00350 from the Division of Research Resources of the National Institutes of Health, Bethesda, Maryland. Manuscript received April 28, 1980; revised manuscript received August 6, 1980, accepted September 24, 1980.
Copyright:
Copyright 2014 Elsevier B.V., All rights reserved.
PY - 1981/2
Y1 - 1981/2
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=0019378774&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0019378774&partnerID=8YFLogxK
U2 - 10.1016/0002-9149(81)90398-2
DO - 10.1016/0002-9149(81)90398-2
M3 - Article
C2 - 7468478
AN - SCOPUS:0019378774
VL - 47
SP - 279
EP - 286
JO - American Journal of Cardiology
JF - American Journal of Cardiology
SN - 0002-9149
IS - 2
ER -