Evaluation of tricuspid regurgitation by pulsed Doppler and two-dimensional echocardiography.

Miyatake, Kunio; Okamoto, Masahiro; Kinoshita, Naokazu; Ohta, Mitsushige; Kozuka, T; Sakakibara, Hiroshi; Nimura, Yuji

doi:10.1161/01.cir.66.4.777

Cited by 212 publications

(55 citation statements)

References 14 publications

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“…We found, like others [12], that the Doppler assess ment of tricuspid regurgitation compared favourably with that obtained by right ventricular angiography and is not hampered by disturbances of rhythm or possible mechanical interference of valve function that may oc cur during right ventricular angiography.…”

Section: Surgical Findingssupporting

confidence: 80%

“…Abnormal pansystolic Doppler signals detected in the right atrial cavity were interpreted to indicate tricus pid regurgitation. The severity of regurgitation was graded on a four-point scale based on the distance reached by the abnormal sys tolic signals from the tricuspid orifice towards the posterior wall of the right atrium as described by Miyatake et al [12]: 1+ = less than 1.5 cm; 2+ = 1.5 cm or more and less than 3 cm; 3+ = 3 cm or more and less than 4.5 cm; 4+ = 4.5 cm or more.…”

Section: Introductionmentioning

confidence: 99%

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Accuracy of Doppler Echocardiography in Detecting and Quantifying Tricuspid Stenosis and Obstructed Tricuspid Prostheses

Fawzy¹,

Mercer²,

Dunn³

et al. 1991

Am J Noninvas Cardiol

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Twenty patients (14 with native and 6 with prosthetic tricuspid valves) with tricuspid stenosis were studied by Doppler echocardiography, followed by cardiac catheterization within 24 h. The tricuspid mean diastolic pressure gradient (MDG) was calculated by the modified Bernoulli equation. Tricuspid valve area (TVA) was calculated by the pressure half-time (1/2 T) method. Data from Doppler echocardiography and cardiac catheterization were compared. The Doppler-derived tricuspid MDG was 1.9-13 (mean 5.8 ± 2.9) mm Hg which correlated moderately well with the catheterization-determined MDG of 2-17 (mean 7.3 ± 3.9) mm Hg, R = 0.65, standard error of the estimate (SEE) was 2.26 mm Hg, y = 0.48x + 2.27, p < 0.05. The Doppler-derived TVA using the equation 220/P 1/2T was 0.4-1.98 (mean 1.20 ± 0.45) cm^2, using the equation 190/P 1/2T it was 0.38-1.7 (mean 1.0 ± 0.38) cm^2, respectively, and had a good correlation with the catheterization-determined TVA of 0.3 -2.2 (mean 1.0 ± 0.48) cm^2, R = 0.82, SEE = 0.26 cm^2, y = 0.78x + 0.42, p < 0.001 and R = 0.82, SEE = 0.22, regression equation y = 0.66x + 0.37, p < 0.001, respectively. Of 14 patients undergoing right ventricular angiography, the angiographic and Doppler grades of tricuspid regurgitation matched exactly in 8, but were different by one grade in the remaining 6 patients. All 6 patients with an obstructed tricuspid prosthesis were correctly diagnosed by Doppler echocardiography. This study demonstrates that Doppler echocardiography is accurate in the diagnosis and quantification of tricuspid stenosis and obstructed tricuspid prostheses and compares well with cardiac catheterization.

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Section: Surgical Findingssupporting

confidence: 80%

Section: Introductionmentioning

confidence: 99%

Accuracy of Doppler Echocardiography in Detecting and Quantifying Tricuspid Stenosis and Obstructed Tricuspid Prostheses

Fawzy¹,

Mercer²,

Dunn³

et al. 1991

Am J Noninvas Cardiol

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“…In the three patients with idiopathic pulmonary artery dilatation mean pulmonary artery pressure and total pulmonary vascular resistance were 10 mm Hg and 134 dyn s cm-5 in the round type, 11 …”

Section: Blood Flow Pattern In Idiopathic Pulmonary Artery Dilatationmentioning

confidence: 83%

Analysis of blood flow in pulmonary hypertension with the pulsed Doppler flowmeter combined with cross sectional echocardiography.

Okamoto¹,

Miyatake²,

Kinoshita³

et al. 1984

Heart

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SUMMARY Blood flow patterns were analysed at nine points in the pulmonary area using the pulsed Doppler technique combined with cross sectional echocardiography in 53 patients with heart disease and 10 healthy subjects. In subjects with a normal pulmonary artery pressure the blood flow pattern in systole showed a gradual acceleration and deceleration with a rounded summit in mid systole, designated the round type. In patients with pulmonary hypertension it showed a rapid acceleration and early deceleration with a sharp peak in early systole, designated the triangular type. The acceleration time index, defined as the ratio of the time interval from the beginning to the peak of ejection to the ejection time, showed a significant inverse correlation with mean pulmonary artery pressure. In pulmonary hypertension a prominent reverse flow occurred in the right posterior part of the pulmonary trunk during mid-systole and early diastole, indicating the presence of a vortex. Similar flow patterns were also seen in patients with idiopathic pulmonary artery dilatation. The factors responsible for the triangular type were principally the reduced capacitance and increased impedance of the pulmonary vascular tree. Those responsible for the reverse flow were the curved path of the blood flow and the dilatation of the pulmonary artery.The development of the pulsed Doppler ultrasound technique has provided a non-invasive method of examining the blood flow in deep lying blood vessels and cardiac chambers. The usefulness of this technique in detecting abnormal flow in valvular and congenital heart disease has been well established. 1 -18 In this study we analysed the blood flow pattern in the pulmonary artery with special reference to changes in pulmonary hypertension using this technique. Patients and methodsTwenty four patients with aortic and mitral valve disease and 26 with a secundum atrial septal defect were studied. Three patients with idiopathic pulmonary artery dilatation were also studied for comparison. Accepted for publication 27 October 1983 tion and angiography. Mean pulmonary artery pressure was higher than 25 mm Hg in 23 of the 50 patients, and none of three with idiopathic pulmonary artery dilatation had pulmonary hypertension. Ten healthy subjects were also examined as controls. EQUIPMENTThe system used consisted of a directional pulsed Doppler flowmeter (Hitachi Medico EUD-4Z) and a commercially available electrocardiogram gated compound cross sectional echocardiograph based on the stop motion principle (Aloka SSDA120). Details of this system have been previously described.8 A transducer attached to a guide arm to indicate the position and the angle of the transducer was used for both the Doppler flowmeter and the echocardiograph by switching the mode of display (Fig. 1). The ultrasound frequency of the Doppler flowmeter was 2-5 MHz and the pulse repetition rate 4-5 kHz or 6-3 kHz. The size of the sample volume was 6 mm (width) x 5 mm (depth). The frequency spectrum of the Doppler signals was analysed with a re...

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“…The patients ranged in age from 14 to 58 years (mean 42). The cause of CHE was idiopathic dilated cardiomyopathy in 13, ischemic heart disease in eight, and valvular heart disease in three. The mean follow-up period was 13 months (range I to 29) with 16 transplant recipients followed for at least 1 year.…”

Section: Methodsmentioning

confidence: 99%

Time course of resolution of pulmonary hypertension and right ventricular remodeling after orthotopic cardiac transplantation.

et al. 1987

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Most patients with severe congestive heart failure have secondary pulmonary hypertension (PHT). Elevation of pulmonary vascular resistance (PVR) to greater than 480 dynes sec cm-5 (6 Wood units) is currently the principle hemodynamic contraindication to orthotopic cardiac transplantation. We performed serial two-dimensional Doppler echocardiographic examinations and right heart catheterizations in 24 recipients (21 men, 14-58 years old) of orthotopic cardiac transplants to determine the time course of resolution of PHT and the concomitant remodeling of the donor right ventricle. Right and left heart filling pressures declined in parallel and reached the upper normal range at 2 weeks after the transplant procedure and remained unchanged at 1 year follow-up. Mean pulmonary arterial pressure (mm Hg) decreased from 38 + 9 preoperatively to 22 ± 5 at 2 weeks and was 19 + 5 at 1 year after the transplantation procedure. At 1 year after surgery, PVR had decreased from 202 + 89 dynes.sec-cm-5 preoperatively to 99 + 36 dynes-sec cm-5 (p < .001), while cardiac output increased from 3.7 + 1.2 to 6.3 1.5 liters/min (p < .001). Echocardiographic analysis showed that transplant recipients had an enlarged right ventricle on day 1 after surgery, and a volume overload contraction pattern and tricuspid regurgitation was present in the majority. This increase in right ventricular size was maintained at 1 year follow-up while the incidence of tricuspid regurgitation decreased. We conclude that there is rapid resolution of moderately elevated pulmonary arterial pressures after cardiac transplantation. The donor right ventricle responds to the abnormal recipient pulmonary circulatory dynamics by developing early dilatation and tricuspid regurgitation that persists despite resolution of PHT. Circulation 76, No. 4, 819-826, 1987. PATIENTS with severe class IV congestive heart fail-

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Evaluation of tricuspid regurgitation by pulsed Doppler and two-dimensional echocardiography.

Cited by 212 publications

References 14 publications

Accuracy of Doppler Echocardiography in Detecting and Quantifying Tricuspid Stenosis and Obstructed Tricuspid Prostheses

Accuracy of Doppler Echocardiography in Detecting and Quantifying Tricuspid Stenosis and Obstructed Tricuspid Prostheses

Analysis of blood flow in pulmonary hypertension with the pulsed Doppler flowmeter combined with cross sectional echocardiography.

Time course of resolution of pulmonary hypertension and right ventricular remodeling after orthotopic cardiac transplantation.

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