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ACC/AHA 2008 Performance Measures for Adults With ST-Elevation and Non–ST-Elevation Myocardial Infarction

ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease
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J Am Coll Cardiol, 2007; 50:1491-1497, doi:10.1016/j.jacc.2007.06.042 (Published online 21 September 2007).
© 2007 by the American College of Cardiology Foundation
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Restrictive Right Ventricular Physiology

Its Presence and Symptomatic Contribution in Patients With Pulmonary Valvular Stenosis

Yat-Yin Lam, MRCP*,§,*, Mehmet G. Kaya, MD*, Omer Goktekin, MD*, Michael A. Gatzoulis, MD, PhD*,{ddagger}, Wei Li, MD, PhD*,{dagger},{ddagger} and Michael Y. Henein, MSc, PhD{dagger},||

* Adult Congenital Heart Unit, Royal Brompton Hospital, London, United Kingdom
{dagger} Department of Echocardiography, Royal Brompton Hospital, London, United Kingdom
{ddagger} National Heart and Lung Institute, Imperial College, London, United Kingdom
§ Division of Cardiology, S. H. Ho Cardiovascular and Stroke Centre, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
|| West Middlesex University Hospital, London, United Kingdom.


Figure 1
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  		Figure 1 Relationship Between RVSP and Long-Axis Velocities (TSa, TEa) in Patients Without and With Restrictive RV Physiology

(A,B) Patients without restrictive right ventricular (RV) physiology; (C,D) patients with restrictive RV physiology. RVSP = right ventricular systolic pressure; TSa, TEa = tissue Doppler imaging lateral tricuspid annular peak systolic and early diastolic velocity, respectively.

 

Figure 2
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  		Figure 2 Example of a Pulmonary Valvular Stenosis Patient With Restrictive RV Physiology

(A) Continuous-wave (CW) Doppler recording showed the antegrade pulmonary flow in late diastole (yellow arrow) which was coincident with premature pulmonary valve opening during atrial systole (indicated by P-wave of electrocardiographic tracing). A CW Doppler instead of pulsed-wave (PW) Doppler recording was shown to illustrate severe pulmonary stenosis (estimated peak pulmonary valve gradient >100 mm Hg). (B, C) Prominent diastolic flow reversals (white arrows) seen after atrial systole in hepatic vein (B) and superior vena cava (C). (D) Prominent diastolic flow reversal (red) in the hepatic vein could be better visualized with color M-mode technique. (E) A PW Doppler recording of tricuspid inflow showed a short E-wave deceleration time with a high A-wave velocity. (F) A PW tissue Doppler imaging trace at the lateral tricuspid annulus showed depressed peak systolic (Sa) and early diastolic (Ea) velocities. RV = right ventricular.

 
 
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