Color Flow Doppler Mapping Studies of “Physiologic” Pulmonary and Tricuspid Regurgitation: Evidence for True Regurgitation as Opposed to a Valve Closing Volume

Benedito C. Maciel, Iain A. Simpson, Lilliam M. Valdes-Cruz, Franco Recusani, Brian Hoit, Nancy Dalton, Robert Weintraub, David J. Sahn

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Abstract

Color flow Doppler mapping using either an Aloka 880 or a Toshiba SSH65A system was performed in 39 normal subjects (aged 13 to 45 years) and 43 patients (aged 13 to 82 years) with pathologic tricuspid or pulmonary regurgitation to evaluate the incidence of “physiologic” regurgitation of right heart valves and to determine the differentiating characteristics in the spatial distribution and velocity encoding of “normal” and “pathologic” regurgitant jets. In the normal subjects, tricuspid and pulmonary regurgitation were documented in 32 (83%) and 36 (93%), respectively, and were unrelated to the system being used. Flow acceleration and aliasing were imaged on the right ventricular side of the tricuspid regurgitant orifice and on the pulmonary artery side of the pulmonary valve (in both normal subjects and patients), and indicated flow convergence for true regurgitation through an orifice as opposed to blood being driven retrogradely by the closing valve. Such proximal acceleration was documented in all patients with pathologic tricuspid regurgitation, in 31/32 of the normal subjects with tricuspid regurgitation, and was also observed in 12/15 (80%) of the patients and 4/12 (33%) of normal subjects with pulmonary regurgitation who were examined with the Toshiba system. The dimensions (mean ± SD) of tricuspid regurgitant jets (length [JL] and area [JA]) were consistently larger in the patients than in the normal subjects (JL: 3.4 ± 0.9 vs 1.2 ± 0.5 cm, p < 0.001; and JA: 5.7 ± 2.0 vs 1.4 ± 0.7 cm2, p < 0.001) as were the pulmonry regurgitation jet dimensions (JL: 1.8 ± 0.4 vs 0.9 ± 0.08 cm, p < 0.001; JA: 1.8 ± 0.7 vs 0.3 ± 0.08 cm2, p < 0.001). Digital computer analysis of the spatial distribution color-Doppler-mapped variance as a superimposition of green pixels (mapped in areas where Doppler velocity solutions vary widely) for the tricuspid insufficiency jets showed that the pathologic jets had higher levels of variance encoding (as a rough index of turbulence). These data indicate that physiologic right heart valve regurgitation represents true regurgitant flow rather than a closing volume of the valve and that differentiation of pathologic regurgitation may be possible on the basis of jet dimensions and turbulence.

Original languageEnglish (US)
Pages (from-to)589-597
Number of pages9
JournalJournal of the American Society of Echocardiography
Volume4
Issue number6
DOIs
StatePublished - Jan 1 1991

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ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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