During echocardiographic examination, respiration induces cyclic physiological changes of intracardiac haemodynamics, causing normal variations of the right and left ventricle Doppler inflows and outflows and physiological variation of extracardiac flows. The respiration related hemodynamic variation in intra and extracardiac flows may be utilized in the echocardiography laboratory to aid diagnosis in different pathological states. Nevertheless, physiologic respiratory phases can cause excessive translational motion of cardiac structures, lowering 2D image quality and interfering with optimal Doppler interrogation of flows or tissue motion. This review focuses on the impact of normal respiratory cycle and provocative respiratory maneuvers in echocardiographic examination, both in physiological and pathological states, emphasizing their applications in specific clinical situations.Respiration induces cyclic physiological modification of intracardiac haemodynamics. Changes are related to variations in intrathoracic and intraabdominal pressure, systemic and pulmonary venous return, intrapericardial pressure, pericardial constraint and interdependence between the four cardiac chambers. With inspiration intrathoracic and intrapericardial pressures decrease. This results in augmented right ventricular filling and stroke volume and, as the total pericardial space is limited, a compensatory decrease in left ventricular stroke volume occurs in early inspiration. With expiration, intrathoracic and intrapericardial pressures increase, resulting in mild decrease in right ventricular diastolic filling and a subsequent increase in left ventricular filling.Because of the constraining effect of the pericardium on the combined volume of the four cardiac chambers, respiratory variation in intrapericardial pressure results in reciprocal variation in the filling of both ventricles [1]. Influence of normal respiration on echocardiographic parameters• 2D echocardiography Image quality With inspiration the anteroposterior diameter of the chest increases, and the lungs inflate and expand particularly anteriorly, partly filling the space between the heart and the thoracic cage. Inspiratory movements do not only decrease the amount of cardiac tissues that lies close to the

Significant improvements of aortic elasticity and of LV diastolic function were recorded at 6 months, and they were maintained at 12 months after LSG. The LV hypertrophy showed also a favorable evolution: it has been slightly improved 6 months after surgery and further ameliorated 1 year postoperatively.

No abstract

No abstract

No abstract