Left and right atrial flow dynamics were compared by means of color and pulsed Doppler in order to study whether color Doppler could reliably provide differentiation between normals [15] and patients without atrial shunt at catheterization [12], vs patients with confirmed atrial septal defect [12]. The procedure consisted of sequential analysis of colored images throughout the cardiac cycle using an apical approach. In addition pulsed Doppler indices were calculated from both annular traces, relating diastolic early (E) and late (A) filling waves at each annulus (E/A); E and A waves were also summed (E + A), and the sum was related between both annuli (Tricuspid/Mitral ratio). Sequential analysis had a 100% sensitivity and specificity for the diagnosis of atrial septal defect, showing an asymmetrical pattern with predominant images in the right atrium, from the 2nd half of systole till End-diastole, vs the symmetrical 'Horseshoe' pattern found over both atria for control subjects. It avoided diagnostic errors due to overriding septal images in systole in 44% of controls. There also was a significant increase of the Tricuspid/Mitral ratios, (for duration and velocity time integral of waves) in patients with atrial septal defect. The correlation coefficient between ratios and values of the Pulmonary/Systemic flow ratio invasively calculated for 10 patients was respectively 0.6 and 0.7 (p less than 0.01). Sequential analysis of colored images appears highly reliable for the diagnosis of atrial septal defect; anomalies of ratios, although of moderate value for predicting shunt magnitude, substantiate the inequality of atrial fillings.

A new methodology for assessment of severity of stenosis employing color Doppler imaging and relying upon spatial and temporal studies of aortic and mitral stenotic jets is described. The spatial study consisted of the detection of the jet origin with respect to upstream and downstream trajectories in the long-axis view, with further identification of each of the three levels from characteristics single-gated Doppler flow recordings, when desired. For the temporal study, color images were gated in midsystole for aortic, and in early diastole for mitral, stenosis. The final step consisted of imaging the jet cross-sectional area in the short-axis view with planimetry. Measurements were compared with those obtained by the Gorlin formula. The procedure was feasible in 43 of 48 studied cases and the correlation between hemodynamic and color Doppler data was satisfactory for both valvular lesions. The best agreement between both methods was for severe stenoses, where the standard error of estimate was the lowest. For large areas the variance in measurements was wider and the correlation coefficient decreased, but this did not cause errors in recognition. This new method provides a convenient and rapid visualization of stenotic jets and is particularly recommended for assessment of severe stenoses, where accuracy was highest for all clinical conditions.