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Pulsed Doppler echocardiographic description of a circular flow pattern in spontaneous left ventricular contrast
B J Delemarre1, H Bot, C A Visser
1Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands.
Insights
Spontaneous intracavitary echoes in patients with dilated left ventricles show a circular flow pattern. This unique Doppler echocardiography finding differs significantly from normal subjects, indicating altered intracardiac hemodynamics.
Area of Science:
- Cardiology
- Medical Imaging
- Physiology
Background:
- Spontaneous intracavitary dynamic echoes (SIDE) are observed in certain cardiac conditions.
- Ischemic heart disease can lead to severe left ventricular dilation.
- Understanding intracardiac flow patterns is crucial for diagnosing and managing heart disease.
Purpose of the Study:
- To investigate the hemodynamic characteristics of spontaneous intracavitary dynamic echoes using pulsed Doppler echocardiography.
- To compare the intracardiac flow patterns in patients with dilated left ventricles due to ischemic heart disease with those in healthy volunteers.
Main Methods:
- Pulsed Doppler echocardiography was performed in nine patients with SIDE and dilated left ventricles and in 22 healthy volunteers.
- Sample volumes were strategically placed in the apical four-chamber view near the lateral wall and interventricular septum.
- Continuous wave Doppler signals were analyzed for flow patterns during systole and diastole.
Main Results:
- Patients exhibited a continuous circular flow pattern with positive signals near the lateral wall and negative signals at the interventricular septum.
- Healthy volunteers showed distinct diastolic and systolic flow patterns, lacking continuous signals.
- A specific angle between the interventricular septum and mitral valve leaflet in patients may contribute to eccentric inflow and circular flow.
Conclusions:
- Spontaneous intracavitary dynamic echoes in dilated left ventricles are associated with a distinct circular intracardiac flow pattern.
- This circular flow pattern, identified by Doppler echocardiography, differs significantly from normal hemodynamics.
- The findings suggest altered diastolic function and potential mechanisms for maintaining this unique flow in ischemic cardiomyopathy.
Abstract:
Pulsed Doppler echocardiography was performed in nine patients with spontaneous intracavitary dynamic echoes, revealing a circular flow pattern. All patients had a severely dilated left ventricle as a result of ischemic heart disease. The sample volume was placed in the apical four-chamber view near the lateral wall and near the interventricular septum, halfway between the mitral valve anulus and apex. A continuous (i.e., during both systole and diastole) positive signal was recorded near the lateral wall and a continuous negative signal at the interventricular septum. This indicates flow continuously toward the transducer along the lateral wall and away from the transducer along the interventricular septum. This is consistent with the circular flow pattern, as demonstrated by the spontaneous intracavitary dynamic echoes. In 22 normal volunteers a positive prominent shift was recorded during diastole near the lateral wall and either a negative (nine of 22) or no (13 of 22) shift at all during systole. Near the interventricular septum a negative systolic shift followed by a positive, early-diastolic shift was consistently recorded. In the large majority (18 of 22) negative waves were recorded during middle and late diastole. A continuous positive or negative Doppler signal was consistently absent in healthy subjects. The angle between the proximal part of the interventricular septum and the anterior mitral valve leaflet during maximal early diastolic opening in the patients was 74 +/- 4.8 degrees (mean +/- SD), which may give rise to a preferential eccentric inflow and the maintenance of the circular apical flow pattern.