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.