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Detection of valvar obstruction by intracardiac masses using Doppler echocardiography
L M Shapiro1, D Mulcahy, P Urban
1National Heart Hospital, London, U.K.
Insights
Intracardiac masses can cause significant heart valve problems, including stenosis and regurgitation. Doppler ultrasound effectively assesses these hemodynamic changes, offering a safer alternative to cardiac catheterization for evaluating valve function in patients with intracardiac masses.
Area of Science:
- Cardiology
- Medical Imaging
- Echocardiography
Background:
- Intracardiac masses pose a risk of valvular dysfunction.
- Accurate hemodynamic assessment is crucial for managing these patients.
- Cardiac catheterization carries inherent risks in this population.
Purpose of the Study:
- To investigate the impact of intracardiac masses on heart valve function.
- To evaluate the utility of Doppler echocardiography in assessing valvular involvement.
- To compare Doppler findings with those of cross-sectional echocardiography.
Main Methods:
- Cross-sectional and Doppler echocardiography were performed on seven patients.
- Hemodynamic parameters such as peak transvalvar velocity and pressure half-time were analyzed.
- Echocardiographic findings were correlated with the presence and type of intracardiac masses.
Main Results:
- Valvular obstruction and regurgitation were observed in cases of prosthetic valve vegetations and endocarditis.
- Mitral stenosis was associated with left atrial myxomata and endocarditis.
- Tricuspid stenosis was linked to right ventricular masses (tumors, thrombus).
- Doppler-derived stenosis patterns mimicked rheumatic heart disease.
Conclusions:
- Intracardiac masses frequently lead to significant valvular abnormalities.
- Doppler echocardiography provides adequate assessment of hemodynamic alterations.
- Doppler ultrasound complements cross-sectional echocardiography for evaluating valvular involvement.
- Doppler ultrasound is a valuable, less invasive tool compared to cardiac catheterization.
Abstract:
The purpose of this paper was to examine valvar involvement in patients with intracardiac masses. Seven patients with intracardiac masses were studied by cross-sectional and Doppler echocardiography. In one, a candida vegetation on a mitral Starr-Edwards prosthesis obstructed the aortic valve with a peak transvalvar velocity of 2 m/sec and aortic regurgitation. Another patient with endocarditis demonstrated mitral stenosis as did two patients with left atrial myxomata. Tricuspid stenosis was demonstrated in three patients with right ventricular intracardiac masses (primary and secondary tumour and thrombus). By Doppler, the mitral and tricuspid stenosis was similar to from that seen in rheumatic heart disease with increased peak transvalvar velocity and prolonged pressure half-time. Because of the hazards associated with cardiac catheterisation in intracardiac masses, we conclude that Doppler ultrasound allows for the adequate assessment of the haemodynamic alterations so as to complement the images obtained by cross-sectional echocardiography.