Tetsuro Ohta

Effect of left and right lateral decubitus positions on mitral flow pattern by Doppler echocardiography in congestive heart failure

Abstract In patients with congestive heart failure (CHF), dyspnea is a clinical manifestation of pulmonary venous and capillary hypertension. Patients with CHF usually have 1 type of dyspnea that is limited to 1 lateral decubitus position: trepopnea. 1 In general, patients prefer lying on the right lateral to lying on the left lateral decubitus position. Doppler echocardiographic assessment of the mitral flow provides a considerable amount of information regarding the diastolic filling characteristics of the left ventricle. Mitral flow velocity is mainly determined by the pressure gradient between the left atrium and ventricle, and therefore can be considered to represent the driving force across the mitral valve. 2–4 Previous observations suggested that peak early filling velocity is mainly dependent on the initial driving pressure across the mitral valve. 5,6 Several investigators have shown that increased left atrial pressure increases the early diastolic mitral pressure gradient and peak mitral flow velocity in early diastole, resembling the normal pattern (“pseudonormalization”). 7–9 Little attention is given to the effects of positions on Doppler-derived mitral flow velocities. This study examines the effects of the left and right lateral decubitus positions on Doppler-derived mitral flow velocities in patients with CHF.

Effects of supine and lateral recumbent positions on pulmonary venous flow in healthy subjects evaluated by transesophageal Doppler echocardiography

OBJECTIVES This study attempted to evaluate the effects of supine and lateral recumbent positions on pulmonary venous flow by transesophageal Doppler echocardiography in healthy subjects. BACKGROUND Although transesophageal echocardiographic examination is usually performed with the patient lying in the left lateral decubitus or supine position, little attention has been paid to the effects of these positions on pulmonary venous flow. METHODS We performed pulsed Doppler transesophageal echocardiography of the left and right pulmonary veins in 16 normal subjects as they lay in the left and right lateral decubitus and supine positions. RESULTS Data are reported as mean value +/- SD. Adequate recordings were obtained in 12 subjects (75%). In the left pulmonary vein, peak systolic velocity and time-velocity integral of systolic flow increased significantly in the left compared with the right lateral decubitus position (56 +/- 12 vs. 44 +/- 13 cm/s, p < 0.05, and 15 +/- 4 vs. 9 +/- 4 cm, p < 0.05, respectively). In the right pulmonary vein, peak systolic velocity and time-velocity integral of systolic flow decreased significantly in the left compared with the right lateral decubitus position (38 +/- 10 vs. 48 +/- 9 cm/s, p < 0.05, and 9 +/- 2 vs. 12 +/- 2 cm, p < 0.05, respectively). There were no significant differences between positions in peak diastolic flow velocity, time-velocity integral of diastolic flow or peak velocity of flow reversal at atrial contraction. CONCLUSIONS Pulmonary venous systolic peak velocities and time-velocity integrals of systolic flow increase when the pulmonary venous recording is from the recumbent subjects lower side. Therefore, the effects of position should be considered in evaluating left ventricular diastolic function by transesophageal Doppler echocardiography.

Detection of coronary blood flow associated with right coronary ostial stenosis by means of transthoracic Doppler echocardiography

We report a case of ostial stenosis of the right coronary artery. Transthoracic echocardiography combined with Doppler flow velocity measurement and color flow imaging allowed noninvasive evaluation of disordered flow caused by stenosis.

LEFT VENTRICULAR LONGITUDINAL DYSFUNCTION ASSESSED BY LONGITUDINAL FRACTIONAL SHORTENING: A CLINICAL TWO-DIMENSIONAL ECHOCARDIOGRAPHIC STUDY

Left ventricular global longitudinal systolic strain (GLS) assessed by speckle-tracking echocardiography has been proposed as a very sensitive parameter for detecting left ventricular early dysfunction at a stage when left ventricular ejection fraction (EF) is still normal. Left ventricular

SEVERITY OF AORTIC REGURGITATION ASSESSED BY AREA OF VENA CONTRACTA- A CLINICAL COLOR DOPPLER IMAGING STUDY

Quantitation of aortic regurgitation (AR) using echocardiography including the width of vena contracta (VC-W) is challenging. Three-dimensional (3D) echocardiography can directly measure the size of vena contracta area of AR jet regardless of rheological characteristics. We intended to assess the