Pulsed and continuous wave Doppler echocardiographic assessment of valvular regurgitation in normal subjects.

To assess the prevalence and flow characteristics of valvular regurgitation detected by Doppler echocardiography in normal subjects, pulsed and continuous wave Doppler studies were performed in 100 adult volunteers without evidence of heart disease. Evidence of valvular regurgitation was present in 73% of subjects. There were 46 subjects with regurgitation of one valve, 24 with regurgitation of two valves and 3 with regurgitation of three valves. Right-sided regurgitation was significantly more common than was left-sided regurgitation (81 versus 22 valves, p less than 0.01). Regurgitant flow was never detected farther than 1 cm from the valve by pulsed Doppler study. Tricuspid regurgitation was detected in 50 subjects and was characterized by a holosystolic velocity signal; a complete spectral envelope was recorded in 32 subjects. The peak velocity of the regurgitant jet for this group was 1.7 to 2.3 m/s (mean 2.0 +/- 0.2). Thirty-one subjects were found to have pulmonary regurgitation with a peak velocity of 1.2 to 1.9 m/s (mean 1.5 +/- 0.2); no subject demonstrated regurgitant flow in early diastole. There were 21 subjects with mitral regurgitation; continuous wave Doppler signals were always of low intensity with a poorly defined spectral envelope and an absence of high velocities. Peak velocities ranged from 1.1 to 4.4 m/s (mean 2.3 +/- 0.9) and in 19 subjects were less than 3.5 m/s. The mean age of subjects with mitral regurgitation was significantly higher than that of subjects without mitral regurgitation (p = 0.01). Aortic regurgitation was detected in only one subject. This study provides further evidence that valvular regurgitation is frequently detected by Doppler echocardiography in normal subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

Reversible tricuspid stenosis. Demonstration with two-dimensional echocardiography and continuous-wave Doppler.

We report a case of pseudo-tricuspid stenosis as a result of extrinsic compression of the tricuspid valve by a large right-sided pericardial effusion. Two-dimensional echocardiography and continuous-wave Doppler enabled accurate noninvasive diagnosis and hemodynamic assessment.

Unsuspected cardiac abnormalities in the acquired immune deficiency syndrome. An echocardiographic study.

To investigate the frequency of unsuspected cardiac abnormalities in AIDS, M-mode and two-dimensional echocardiograms were performed on 27 homosexual males with this syndrome. Twenty-one homosexual males without the disease were used as controls. Subjects with clinical heart disease or a history of intravenous drug abuse were excluded. Fractional shortening was reduced in eight patients (30 percent) and in one control (5 percent) (p less than 0.05). Pericardial effusions were found in seven patients (26 percent); one control subject had a small effusion (5 percent) (p = 0.05). Overall, echocardiographic abnormalities were found in 13 of 27 patients (48 percent) compared with 2 of 21 control subjects (10 percent) (p less than 0.02). We conclude that although often not diagnosed clinically, the incidence of cardiac involvement in AIDS is high.

Use of continuous-wave Doppler ultrasound to evaluate and manage primary pulmonary hypertension.

Doppler ultrasound was used to assess the response to serial drug testing in a patient with primary pulmonary hypertension. There was a close correlation between the pressure estimated by Doppler and the pulmonary arterial systolic pressure measured invasively (r = 0.98). Continuous-wave Doppler ultrasound, although not a substitute for initial Swan-Ganz catheterization, may obviate the need for repeat invasive procedures and permit closer monitoring of patients during treatment.

Large pericardial effusions in the acquired immunodeficiency syndrome.

The increasing importance of the acquired immunodeficiency syndrome (AIDS) as a cause of large, clinically significant pericardial effusions has not been well documented. To determine the frequency and characteristics of large AIDS-associated pericardial effusions, we reviewed the records of 50 consecutive patients undergoing pericardiocentesis between 1985 and 1990; AIDS was the most common underlying illness and was present in 14 patients (28 percent). The pericardial fluid was diagnostic in three (21 percent) of the 14 cases (one bacterial, one positive for acid-fast bacilli, and one lymphoma). Of the 11 patients with nondiagnostic fluid, one underwent a pericardial biopsy which revealed granuloma consistent with mycobacterial disease, four had active pulmonary tuberculosis (TB), and two responded clinically to anti-TB therapy. Thus, in 8 (57 percent) of the 14 patients with AIDS, there was either definitive or suggestive evidence of mycobacterial disease. We conclude that AIDS is now a common underlying illness associated with large pericardial effusions and that mycobacterial disease may frequently be the etiology.

Right-sided endocarditis in intravenous drug users. Prognostic features in 102 episodes.

OBJECTIVE: To describe the clinical, laboratory, and echocardiographic findings in a large group of patients with right-sided endocarditis and to determine whether any of these findings is predictive of prognosis. DESIGN: Retrospective survey of medical records to evaluate the course of hospitalization with follow-up on 6-month survival. Review of two-dimensional echocardiograms by an observer blinded to clinical information. SETTING: Large, metropolitan, voluntary hospital. PATIENTS: One hundred twenty-one intravenous drug users with clinical and bacteriologic evidence of 132 episodes of endocarditis. The presence of a right-sided valvular vegetation detected by two-dimensional echocardiography was required for entry into the study. MEASUREMENTS AND RESULTS: Staphylococcus aureus was the most common infecting organism (82%, 108 of 132). Vegetations involved the tricuspid valve in 127 episodes, the pulmonic in 4, and both in 1; they ranged in size from 0.4 to 4.3 cm (mean, 1.5 +/- 0.7 cm). Vegetations greater than 1.0 cm were present in 106 cases (80%). Among patients with isolated native right-sided endocarditis who reached a definite end point in treatment, mortality was 7% (7 of 98). Vegetations greater than 2.0 cm were associated with a significantly higher mortality compared with vegetations of 2.0 cm or less (33% compared with 1.3%, P less than 0.001). CONCLUSIONS: Overall, right-sided endocarditis has a favorable prognosis. Although complications and prolonged fever are common, most cases respond to medical therapy. Our findings suggest that vegetation size may be an important predictor of outcome and that vegetations greater than 2.0 cm are associated with increased mortality.