[Doppler echocardiography in the genesis of precordial murmurs in patients with morphological changes of the thorax of the pectus excavatum type]. / L'ecocardiografia doppler nella genesi dei soffi precordiali in soggetti portatori di alterazioni morfologiche della gabbia toracica, tipo pectus excavatum.

A complete Doppler effect echocardiographical study was performed on 15 patients with pectus excavatum type deformations of the chest (first, second, and third degree of hollowing). Fourth-degree patients were excluded, since they proved unable to cooperate fully when lying down. An ATL Mark I 500 B Eco Doppler was used in M mode. A typical tricuspid pattern was observed. This was clearly superimposed on the aortic wall, with its D point closely conjoined to the anterior part of the vessel. This finding was obtained by bringing the sound to the 5th intercostal space, in a vertical instead of a medio-lateral orientation. The Doppler effect was normal at the low atrium, mitral, left ventricular efflux chamber almost at the level of the aortic valve, giving rise to a mixed spectral curve, with an aortic shape in the systole and a tricuspid shape in the diastole. A sample volume at the lung level resulted in a spectral curve turning negatively. There was distinct turbulence at its nadir, even though the examination was performed in complete expiratory apnoea. This lung flow turbulence indicated that the acoustic observation of a systolic murmur in some patients was attributable to partial compression exerted by the sunken sternum on the pulmonary artery or its left branch.