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[The ghost intraventricular obstruction. Its detection in the right ventricle by Doppler color]
M Cazzaniga1, M Maître Azcárate, M C Quero Jiménez
1Servicio de Cardiología Pediátrica, Hospital Ramón y Cajal, Madrid.
Insights
Color Doppler echocardiography reveals a distinct systolic jet in the right ventricle of infants with heart conditions. This finding, potentially linked to asynchronous contraction, aids in diagnosing congenital heart malformations.
Area of Science:
- Pediatric Cardiology
- Echocardiography
- Congenital Heart Disease
Background:
- Color Doppler echocardiography is crucial for detecting regional flow acceleration in the left ventricle.
- This technique also confirms flow patterns in the right ventricle of infants with various heart conditions.
Purpose of the Study:
- To investigate a specific Doppler finding in the right ventricle of infants with congenital heart malformations.
- To understand the characteristics and potential causes of this observed phenomenon.
Main Methods:
- Focused on 16 infants (mean age 2.5 months) with diverse congenital heart defects.
- Analyzed Color Doppler echocardiography data, noting jet velocity, direction, and spectral morphology.
Main Results:
- A late systolic jet was observed in the right ventricular apex (1.5-2.9 m/s), directed towards the tricuspid orifice.
- Turbulence was visible in specific echocardiographic views; spectral analysis showed leftward concavity.
- This finding was initially misdiagnosed as an apical ventricular septal defect in two cases.
Conclusions:
- The jet's dynamic nature suggests asynchronous myocardial contraction in hypertrophied right ventricles.
- Increased use of Doppler color technique may lead to more frequent observation of this finding.
- Apical ventricular septal defect should be considered in the differential diagnosis.
Introduction:
The Color Doppler echocardiography is a method of choice to detect the regional acceleration of flow in the left ventricle. The color study confirm it also in the right ventricle of infants with diseases other than hypertrophic cardiomyopathy.
Material:
We centered our attention in this finding observed in 16 infants with a mean age of 2.5 months (3 of whom were neonates) with several congenital heart malformations: 9 immediately after surgical ventricular septal defect closure (A-V canal type in 6, and isolated in 3); 2 with pulmonary atresia+intact septum+reconstruction of right ventricular-pulmonary artery connection; 2 with severe aortic stenosis; 1 with a double outlet right ventricle+pulmonary band; 1 with Jatene operation; finally 1 after balloon pulmonary valvuloplasty.
Results:
The phenomenon consisted in a late Doppler systolic signal in the right ventricular apex whose velocity ranged between 1.5 and 2.9 m/s. The jet was directed towards the tricuspid orifice, with a normal pulmonary flow. The turbulence was easily viewed in the apical four chambers and subcostal sagittal plane of the right ventricle, the spectral signal showed a morphology with left side concavity. An erroneous diagnosis of apical ventricular septal defect was suggested in 2 cases in whom the left ventricular angiogram performed before treatment excluded the lesion.
Conclusion:
The dynamic nature of the jet suggest that an asynchronous order of myocardial contraction in hypertrophic right ventricule play a role in its genesis. With the increasing use of Doppler color technique, this finding can be observed with greater frequency in neonates and infants with operated or unoperated heart diseases and right ventricular hypertrophy. Apical ventricular septal defect will be included in the differential diagnosis.