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Doppler assessment of changes in right-sided cardiac hemodynamics after pulmonary thromboendarterectomy

Authors
Journal
The American Journal of Cardiology
0002-9149
Publisher
Elsevier
Publication Date
Volume
61
Issue
13
Identifiers
DOI: 10.1016/0002-9149(88)90132-4
Disciplines
  • Medicine

Abstract

Abstract It is not known whether Doppler echocardiography can accurately follow changes in right-sided cardiac hemodynamics after a therapeutic intervention in patients with pulmonary artery (PA) hypertension. Therefore, Doppler measurements of the maximal velocity of the tricuspid regurgitant jet and the acceleration time of the PA velocity profile were obtained in 28 patients before and after pulmonary thromboendarterectomy for chronic thromboembolic PA hypertension. Doppler values were compared with hemodynamic variables obtained at cardiac catheterization. Postoperatively, decreases in mean PA pressure (50 ± 14 to 28 ± 8 mm Hg), transtricuspid systolic pressure difference (69 ± 21 to 36 ± 14 mm Hg) and Doppler measurement of the maximal velocity of the tricuspid regurgitant jet (4.1 ± 0.7 to 2.7 ± 0.5 m/s) were noted, while acceleration time increased (57 ± 16 to 94 ± 18 ms, all p < 0.001) compared with preoperative values. For the population as a whole, the calculated systolic transtricuspid pressure difference determined from the maximal velocity of tricuspid regurgitation correlated well with the catheterization systolic transtricuspid pressure difference (r = 0.93, p < 0.001) and the acceleration time correlated with mean PA pressure (r = −0.81, p < 0.001). More importantly, the change in the maximal velocity of tricuspid regurgitation for postoperative patients was found to correlate with the change in catheterization systolic transtricuspid pressure difference (r = 0.82, p < 0.001), while the change in acceleration time correlated weakly with the change in mean PA pressure (r = −0.41, p = 0.053). It is concluded that Doppler echocardiography is accurate in noninvasive assessment of right-sided cardiac pressures in patients with PA hypertension. Of the 2 most commonly used Doppler techniques, the measurement of the maximal velocity of the tricuspid regurgitant jet is more reliable than the measurement of the acceleration time of the PA velocity profile for assessing changes after therapeutic interventions such as pulmonary thromboendarterectomy.

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