ABSTRACT
We studied inferior vena cava contrast echocardiography after upper extremity injection in 70 subjects; 59 were patients and 11 were controls. Inferior vena cava contrast was seen in 35 patients and in 1 control. "A-wave synchronous pattern" of contrast appearance was observed in 13 patients and 1 normal subject. The pattern did not depend upon the height of right atrial a-wave pressure or the right ventricular (RV) end-diastolic pressure, but was related to the respiratory cycle. A "random pattern" of contrast appearance was seen in 3 patients with cardiac arrhythmia and normal right heart hemodynamics. One patient with ventricular premature beats showed both "a-wave synchronous" and "random" patterns. A "v-wave synchronous pattern" was found in 20 patients, of which 17 had tricuspid regurgitation. Persistence of inferior vena cava contrast correlated with the height of right atrial v-wave (r = 0.87, p less than 0.001) and the severity of tricuspid regurgitation estimated from RV cineangiography. The differences of RV systolic pressure and echocardiographic right ventricular dimension between the study patients with and without tricuspid regurgitation did not reach statistical significance. We conclude: the echocardiographic RV dimension and the degree of RV hypertension are not predictors for the presence of tricuspid regurgitation and its severity; inferior vena cava contrast echocardiography may be used to estimate the severity of tricuspid regurgitation.
Subject(s)
Echocardiography/methods , Heart Defects, Congenital/diagnosis , Heart Valve Diseases/diagnosis , Hemodynamics , Pulmonary Heart Disease/diagnosis , Rheumatic Heart Disease/diagnosis , Adolescent , Adult , Arrhythmias, Cardiac/diagnosis , Female , Glucose , Heart Atria/physiopathology , Heart Defects, Congenital/physiopathology , Heart Valve Diseases/physiopathology , Heart Ventricles/physiopathology , Humans , Male , Middle Aged , Pulmonary Heart Disease/physiopathology , Rheumatic Heart Disease/physiopathology , Tricuspid Valve Insufficiency/diagnosis , Vena Cava, InferiorABSTRACT
UNLABELLED: The clinical utility of visualization of blood flow patterns across the tricuspid valve (TV) and pulmonary valve (PV) by M-mode contrast echocardiography was studied in 38 patients with documented valvular or congenital heart disease and in 15 controls. Diastolic turbulence was observed in the TV outflow side in three patients with tricuspid stenosis. Turbulent flow was also detected during systole in patients with septal defects (atrial septal defect in four patients and ventricular septal defect in one patient) in the right ventricular outflow tract and in three atrial septal defect patients also in the inflow tract, presumably because of increased volume of flow. Tricuspid regurgitation (11 patients) was characterized by retrograde laminar jet throughout systole, while in pulmonary regurgitation (six patients) retrograde flow was initially laminar although later on it might become turbulent. In pulmonary hypertension (29 patients) antegrade flow occurred approximately to mid-systole and then was interrupted by retrograde laminar flow which contributed to the mid-systolic closure of the pulmonary valve and pulmonary regurgitation in some cases. CONCLUSIONS: contrast echocardiography is a useful technique to analyse right heart blood flow patterns and may aid the diagnosis of various right heart abnormalities.
