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[Constrictive pericarditis: study by Doppler echography of blood flow in the supra-hepatic veins]
L Goullard1, A Millaire, G Deklunder
1Service d'Explorations fonctionnelles, Hôpital Cardiologique, Lille.
Insights
Doppler ultrasound of supra-hepatic veins reveals distinct blood flow patterns in constrictive pericarditis. These changes, particularly in flow rate peaks, help assess disease severity and progression.
Area of Science:
- Cardiovascular Physiology
- Medical Imaging
- Diagnostic Ultrasound
Context:
- Constrictive pericarditis significantly impacts cardiac function and hemodynamics.
- Assessing the severity of constrictive pericarditis often requires invasive procedures.
- Supra-hepatic veins offer a potentially accessible site for hemodynamic assessment.
Purpose:
- To evaluate the utility of Doppler ultrasound of supra-hepatic veins for assessing constrictive pericarditis.
- To characterize blood flow patterns in supra-hepatic veins in patients with constrictive pericarditis.
- To compare these patterns with those in healthy individuals.
Summary:
- Doppler ultrasound measurements of supra-hepatic vein blood flow in 11 constrictive pericarditis patients showed characteristic alterations.
- These included a decreased X peak (ventricular demand) and an increased Y peak (ventricular filling).
- The influence of respiratory variations on flow diminished with increased constriction, correlating with invasive pressure data.
Impact:
- This non-invasive Doppler ultrasound method provides a quicker and more consistent assessment of constrictive pericarditis than cardiac valve analysis.
- It offers a valuable tool for evaluating the stage of constrictive pericarditis.
- Findings parallel invasive hemodynamic measurements, validating the ultrasound approach.
Abstract:
The blood flow rate in the supra-hepatic veins has been measured by Doppler ultrasound in 11 subjects suffering from more or less advanced constrictive pericarditis; the results were compared to those obtained with normal subjects. In all the pathological cases, the flow rate curve shows the following modifications: a slight decrease in the X peak, which is related to the blood "demand" caused by the decrease in the ventricular volume during the ejection, and a correlative increase in the Y peak, contemporaneous of the ventricular filling up. In the patients in which the pericarditis has not reached a marked stage of constriction, the intra-thoracic ventilatory pressure variations still exert a certain influence on the supra-hepatic blood flow rate; on the other hand, this influence is suppressed when the constriction is complete. These phenomena are parallel to the pressure modifications observed by catheterism and to those of the mitral and tricuspid transvalvular flow. The advantage of measuring the blood flow rate in the supra-hepatic veins lies in the fact that the access, for ultrasound analysis, to these vessels is quicker and more constant than to the heart valves. This method seems therefore to be an interesting one to assess the stage of development of the constricting pericarditis.