Intraoperative Doppler echocardiography in hypertrophic cardiomyopathy: correlations with the obstructive gradient
WJ Stewart,
WA Schiavone,
EE Salcedo,
HM Lever,
DM Cosgrove,
and
CC Gill
Although significant pressure gradients can be recorded across the left ventricular outflow tract in patients with hypertrophic cardiomyopathy, controversy exists regarding the presence or absence of true obstruction. Ten patients with hypertrophic cardiomyopathy were studied at the time of septal myectomy. A sterile continuous wave Doppler transducer was placed on the ascending aorta and directed toward the left ventricular outflow tract to measure velocity simultaneously with invasive gradient measured using solid-state hub transducers by direct puncture of the left ventricle and aorta. Simultaneous Doppler velocity and invasive gradient measurements (n = 33) were made at rest, before and after myectomy and during interventions with isoproterenol, volume loading and phenylephrine. High velocity flow with a characteristic contour was recorded in patients with a significant gradient. Using the modified Bernoulli equation (gradient = 4 X velocity), a good correlation was found between the Doppler-derived gradient and the peak instantaneous gradient measured invasively (r = 0.93, y = 0.89X + 12, p = 0.0001). Changes in gradient and velocity due to interventions also correlated well (r = 0.96, y = 0.91X - 3, p = 0.0001). Continuous wave Doppler echocardiography can accurately estimate the outflow tract gradient. The magnitude, timing and contour of these high velocity flow signals support the hypothesis that true obstruction is present in patients with hypertrophic cardiomyopathy who have a significant gradient.
This article has been cited by other articles:
|
|
|
|
 
R. K. Kaple, R. T. Murphy, L. M. DiPaola, P. L. Houghtaling, H. M. Lever, B. W. Lytle, E. H. Blackstone, and N. G. Smedira
Mitral Valve Abnormalities in Hypertrophic Cardiomyopathy: Echocardiographic Features and Surgical Outcomes
Ann. Thorac. Surg.,
May 1, 2008;
85(5):
1527 - 1535.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. Baumgartner, T. Stefenelli, J. Niederberger, H. Schima, and G. Maurer
"overestimation" of catheter gradients by doppler ultrasound in patients with aortic stenosis: a predictable manifestation of pressure recovery
J. Am. Coll. Cardiol.,
May 1, 1999;
33(6):
1655 - 1661.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. G. Cape, M. Jones, I. Yamada, M. D. VanAuker, and L. M. Valdes-Cruz
Turbulent/Viscous Interactions Control Doppler/Catheter Pressure Discrepancies in Aortic Stenosis: The Role of the Reynolds Number
Circulation,
December 1, 1996;
94(11):
2975 - 2981.
[Abstract]
[Full Text]
|
|
|
|
|
|
|
J. Niederberger, H. Schima, G. Maurer, and H. Baumgartner
Importance of Pressure Recovery for the Assessment of Aortic Stenosis by Doppler Ultrasound: Role of Aortic Size, Aortic Valve Area, and Direction of the Stenotic Jet In Vitro
Circulation,
October 15, 1996;
94(8):
1934 - 1940.
[Abstract]
[Full Text]
|
|
|
|
|
|
|
J. Bartunek, S. U. Sys, A. C. Rodrigues, E. Van Schuerbeeck, L. Mortier, and B. de Bruyne
Abnormal Systolic Intraventricular Flow Velocities After Valve Replacement for Aortic Stenosis : Mechanisms, Predictive Factors, and Prognostic Significance
Circulation,
February 15, 1996;
93(4):
712 - 719.
[Abstract]
[Full Text]
|
|
|
|
|
|
|
F. S. Joyce, H. M. Lever, and D. M. Cosgrove III
Treatment of hypertrophie cardiomyopathy by mitral valve repair and septal myectomy
Ann. Thorac. Surg.,
April 1, 1994;
57(4):
1025 - 1027.
[Abstract]
[PDF]
|
|
|
|
