Color and pulsed Doppler studies of atrial flow dynamics in normals and adult patients with uncomplicated atrial septal defects

Abstract

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.

Abnormal cardiac inflow patterns during postnatal development in a mouse model of Holt-Oram syndrome

“…Because of ASD in Tbx5 del/ϩ mice, the direction of the shunting through the septum may complicate the interpretation of the ventricular filling patterns. In Tbx5 del/ϩ mice, the increased peak E and A velocities and TVI in a dilated tricuspid orifice suggest the existence of volume overload in the right heart due to a left-to-right shunting, as customarily seen in humans with ASD (19,30,34). On the other hand, a generally reduced retrograde A wave in the pulmonary vein suggests that the pressure in the left atrium is not elevated.…”

“…In humans with ASD, right ventricular dilatation significantly alters left ventricular geometry (e.g., a flattened inter- ventricular septum toward the left ventricle at end systole and early diastole and decreased left ventricular chamber dimension), increases left ventricular chamber stiffness and reduces its compliance, and consequently impairs left ventricular filling (3,6,17). However, all these abnormalities are not associated with significant changes in the mitral flow pattern in patients with normal pulmonary pressure (21,30,34). Human patients with similar right ventricular enlargement but normal to moderately elevated pulmonary pressure do not have mitral flow patterns significantly different from those in normal subjects.…”

Scintigraphic diagnosis of a right to left shunt in end-stage lung disease

“…Lung scintigraphy was performed with a protocol that has already been described (14,15). Ventilation studies were acquired using 400^700 MBq of Xenon (Xe)-133 in the posterior projection while perfusion scans were subsequently acquired after the i.v.…”