Patterns and timing of Doppler-detected intracavitary and aortic flow in hypertrophic cardiomyopathy

This study describes the velocity characteristics of left ventricular and aortic outflow in 25 patients with hypertrophic “obstructive” cardiomyopathy. Systematic pulsed and continuous wave Doppler analysis combined with phonocardiography and M-mode echocardiography was used to establish the pattern and timing of outflow in the basal and provoked states. This analysis suggests that 1) the high velocity left ventricular outflow jet can be reliably discriminated from both aortic flow and the jet of mitral regurgitation using Doppler ultrasound; 2) the Doppler velocity contour responds in a characteristic fashion to provocative influences including extrasystole and Valsalva maneuver; 3) the onset of mitral regurgitation occurs well before detectable systolic anterior motion of the mitral valve; 4) left ventricular flow velocities are elevated at the onset of systolic anterior motion of the mitral valve, suggesting a significant contribution of the Venturi effect in displacing the leaflets and chordae; 5) the high velocities of the outflow jets are largely dissipated by the time flow reaches the aortic valve; and 6) late systolic flow in the ascending aorta is nonuniform, with formation of distinct eddies that may contribute to “preclosure” of the aortic valve

Diagnostic role of Doppler echocardiography in constrictive pericarditis

AbstractObjectives. This study was conducted to assess the diagnostic role of Doppler echocardiography in constrictive pericarditis.Background. It has been observed that ptients with constrictive pericarditis have a characteristic Doppler pattern of respiratory variation in ventricular filling and central venous flow velocities. However, the observation was based on a small number of patients with known diagnosis.Methods. We reviewed the echocardiographic features of 28 patients (21 mem and 7 women; mean age ± SD 55 ± 15 years) with suspected constrictive pericarditis who underwent exploratory thoracotomy or pericardiectomy.Results. At operation, constrictive pericarditis was diagnosed in 25 patients, restriction in 1 and normal pericardium in 2. Of the 25 patients with constriction, correct preoperative Doppler diagnosis was made in 22 (88%) and Doppler echocardiography showed restriction in 3. In two patients with a normal pericardium, Doppler features were consistent with constriction in one patient and were normal in the other. In the one patient with restriction, Doppler echocardiography showed restriction. In 19 patients with surgically proved constriction, repeat Doppler study after pericardiectomy showed normal findings in 14 and restriction in 5. Twelve of the 14 patients with normalized Doppler findings became asymptomatic, whereas all 5 with restrictive Doppler features remained symptomatic.Conclusions. Doppler echocardiography performed simultaneously with respiratory recording is highly sensitive for diagnosing constrictive pericarditis, and it appears to predict functional response to pericardiectomy