Estimation of the ratio of pulmonary to systemic pressures by pulsed-wave Doppler echocardiography for assessment of pulmonary arterial pressures.

This study describes a method for estimation of the ratio of pulmonary to systemic pressures by pulsed-wave Doppler echocardiography. Sixty-eight patients ages 1 day to 68 years who underwent cardiac catheterization had Doppler studies of the right and left ventricular outflows. Preejection period (PEP), ejection time (ET) and mean acceleration to peak velocity (ACCm) were measured on each waveform. The expression: F = (PEP x ACCm)/ET was calculated for right and left ventricular outflows as an index of the effects that the interaction between ventricular contraction and afterload has on the shape of the Doppler waveforms generated in each outflow. The quotient of (F for the right outflow)/(F for the left outflow), or waveform contour ratio, was used to express the degree of pressure-dependent variability between each subject's right and left ventricular outflow tracings. The waveform contour ratio was strikingly similar to the ratio of systolic pulmonary to systemic pressures and also closely correlated to the ratio of mean pressures. The product of waveform contour ratio and arm systolic pressure gave a consistently accurate estimate of systolic pulmonary pressures. It is concluded that the present method can be used successfully for the noninvasive assessment of pulmonary arterial pressures.

Hemodynamics of the Mueller maneuver in man: right and left heart micromanometry and Doppler echocardiography.

Ten subjects with normal hemodynamics were studied during elective cardiac catheterization with right and left heart multisensor micromanometry to assess hemodynamic responses to the Mueller maneuver. Simultaneous right and left circulatory hemodynamics and left ventricular, pulmonary arterial, and aortic pressures were recorded, in addition to pulmonary arterial and aortic flow velocities. Steady-state cardiac outputs were determined by thermal dilution. Aortic systolic and mean pressures were not significantly changed during the Mueller maneuver, in contrast to a lower diastolic (p = .019) and higher pulse pressure (p = .016). Mean right atrial pressure (+/- SE) decreased from 7 +/- 1 to -17 +/- 4 mm Hg (p = .0002) and the right atrial "x" descent was markedly accentuated. Left ventricular end-diastolic pressure decreased from 12 +/- 4 to -3 +/- 13 mm Hg (p = .0025). Systemic vascular resistance and left ventricular peak positive dP/dt were increased during the Mueller maneuver (p less than .02), cardiac output and stroke volume were reduced (p less than .05), and there was no significant change in heart rate. Right and left peak flow velocities showed a trend toward a bilateral decrease (right, p = .054; left, p greater than .1), and times to peak flow velocity were increased in the pulmonary artery (p = .007) and reduced in the aortic root (p = .03). Normal subjects were studied separately by pulsed Doppler echocardiography. During the sustained Mueller maneuver, the internal jugular and right ventricular dimensions decreased, and superior vena cava Doppler flow was reduced.(ABSTRACT TRUNCATED AT 250 WORDS)

Acquired left ventricular-coronary sinus fistula: demonstrated by pulsed Doppler echocardiography.

Communications between the left ventricle and the right atrium are rare. A left ventricle to coronary sinus fistula is an extremely rare form of left ventricular-right atrial shunt. This is the first report of such a shunt following myocardial infarction, and emphasizes the use of two-dimensional and pulsed Doppler echocardiography in making the diagnosis.

Pulsed Doppler study of a case of coarctation of the aorta: demonstration of a continuous Doppler frequency shift.

Pulsed Doppler echocardiography was used to assess flow across a severe coarctation of the aorta. The high peak systolic Doppler frequency shift correlated well with the gradient measured at cardiac catheterization. A Doppler frequency shift was present throughout diastole, suggesting pan-diastolic flow across the coarctation. This finding may be a marker of severe coarctation of the aorta.

The occurrence of disseminated coccidioidomycosis in a patient with Crohn's disease.

We describe the clinical and morphologic findings in a 22-year-old man with Crohn's disease and disseminated coccidioidomycosis. The altered immune state postulated to exist in Crohn's disease could have a relation to disseminated coccidioidomycosis.