Systolic direction of right ventricular contrast trajectories in the detection of ventricular septal defect with left-to-right shunt

Abnormal systolic direction of contrast flow toward the transducer within the right ventricle was demonstrated on M-mode echocardiograms in patients with ventricular septal defect (VSD) and left-to-right shunt. The usefulness of this new technique was tested in 30 patients with VSD proved at catheterization and in 300 control subjects. In all subjects, 2-dimensional (2-D) visualization of the defect, 2-D negative contrast effect and M-mode demonstration of positive contrast within the left ventricular (LV) cavity were also performed. Sensitivity and specificity for each technique and each hemodynamic subgroup of patients were determined and compared. A sensitivity of 100% for the diagnosis of VSD by anterior right ventricular (RV) systolic direction of contrast trajectories was achieved in 20 patients with relatively small VSDs and mild to moderate elevation of RV pressure (RV-LV pressure ratio 60%) and mean pulmonary to systemic blood flow ratio of 1.7. Sensitivities of 2-D echocardiography, 2-D negative contrast technique and positive LV contrast appearance on M-mode echocardiography were 63%, 71% and 53%, respectively. Sensitivity of 100% for systolic anterior direction of contrast trajectories was also calculated in 6 patients with RV-LV pressure ratios from 61 to 80% and mean pulmonary to systemic blood flow ratio of 2.7. Sensitivities of 2-D echocardiography, 2-D negative contrast technique and positive contrast appearance in the LV cavity by M-mode echocardiography were 75%, 60% and 86%, respectively. In 4 patients with systemic or nearly systemic RV pressure, sensitivity of systolic anterior direction of RV contrast trajectories decreased drastically, to only 67%.(ABSTRACT TRUNCATED AT 250 WORDS)