[The evaluation of pulmonary artery pressure by suprasternal notch M-mode echocardiography]

Four hundred subjects without any sign of cardiac disease were studied by M-Mode echocardiography both by the parasternal approach, in order to record the pulmonary valve and by the suprasternal approach, in order to visualize the aortic arch and right pulmonary artery. Successful recordings were obtained respectively in 70.2% and 92.7% of the attempts. Furthermore we examined with both approaches, 20 patients (pts) with rheumatic mitral valve disease and mean pulmonary artery pressure (mPAP) greater than 20 mmHg (group A), 20 pts with rheumatic mitral valve disease and mPAP less than or equal to 20 mmHg (group (B) and 20 healthy subjects, homogeneous for age and sex (group C). In group A, the pulmonary valve was well recorded by the parasternal approach in 14 pts (70%). Only 9 (45%) showed a diagnostic pattern of pulmonary hypertension. By suprasternal echocardiography we measured the aortic arch/right pulmonary artery end-diastolic ratio: this index, successfully obtained in all pts of group A, B and C, was significantly (p less than 0.001) lower in group A versus group B and C and was significantly correlated (r = 0.84) with mPAP. We, therefore, conclude that the suprasternal M-Mode echocardiographic evaluation of the pulmonary artery is technically easier than the parasternal visualization of the pulmonary valve. Furthermore, it seems to be able to detect more accurately, at least in a selected population, pts with pulmonary hypertension.