Elevated Right Ventricular End‐Diastolic Pressure by Doppler Echocardiography—A Case Report

Abstract

Careful analysis of the right-sided Doppler signals provides important data regarding right heart hemodynamics. Here, we illustrate the value of the combined analysis of flow across the hepatic vein, tricuspid valve, and pulmonary valve for the diagnosis of elevated right ventricular end-diastolic pressure.

Spectral Doppler of the Hepatic Veins in Pulmonary Hypertension

“…Importantly the HV A‐wave persistently exceeds in duration with the forward A‐wave on the TV inflow Doppler and often shows minimal variability with respiration (Fig. B) . This pattern represents the main finding on HV Doppler in patients with significant PHTN…”

“…The resulting HV Doppler demonstrates a large A‐wave reversal with increased A‐wave duration and velocity (Fig. A–B) . Importantly the HV A‐wave persistently exceeds in duration with the forward A‐wave on the TV inflow Doppler and often shows minimal variability with respiration (Fig.…”

“…2A-B). 10 Importantly the HV A-wave persistently exceeds in duration with the forward A-wave on the TV inflow Doppler and often shows minimal variability with respiration ( Fig. 2B).…”

“…2B). [10][11][12] This pattern represents the main finding on HV Doppler in patients with significant PHTN. 7,11 Delay in TV Opening: Pulmonary hypertension is associated with prolongation of the right-sided isovolumic relaxation time (IVRT) due to impairment in RV myocardial relaxation.…”

Spectral Doppler of the Hepatic Veins in Rate, Rhythm, and Conduction Disorders

“…4 Such a pattern mimics an elevation in RV end-diastolic pressure (RVEDP). 4,7 Identification of the same phenomenon in the PV Doppler together with a collapsible inferior vena cava and recognition of the short PR interval help diagnose this entity. 8 Importantly, the effect of the short PR interval is less pronounced in the HVs than in the PVs due to the later closure of the TV than the mitral valve.…”