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(A) The normal pulsed Doppler pattern seen with mitral valve inflow

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1 (A) The normal pulsed Doppler pattern seen with mitral valve inflow
(A) The normal pulsed Doppler pattern seen with mitral valve inflow. Note the E/A >1 (E wave: single arrowhead; A wave: double arrowheads). The best flow patterns are recorded with the sample volume placed at the mitral valve tips in the apical four-chamber or apical two-chamber views. (B) Mitral valve inflow recording with pulsed-wave Doppler showing evidence of mild diastolic relaxation abnormality, with E/A < 1 (E wave: single arrowhead; A wave: double arrowheads). (CL) A normal tissue Doppler pattern recorded at the mitral valve leaflet. The Ea/Aa > 1. Note the placement of the sample volume at the lateral aspect of the mitral leaflet (Ea: single arrowhead; Aa: double arrowheads). (CR) Tissue Doppler recording of the mitral valve in a patient demonstrating a diastolic relaxation abnormality. Note the reversal of the Ea/Aa to <1. Because the annular velocity is not volume dependent, obtaining a tissue Doppler avoids the issue with pseudonormalization seen with mitral valve inflow velocity pulsed-wave Doppler measurements in patients with mild diastolic dysfunction (Ea: single arrowhead; Aa: double arrowheads). (D) Normal isovolumic relaxation time (IVRT) is demonstrated here. The IVRT decreases with progressive diastolic dysfunction. (E) This demonstrates the normal deceleration time (DT) on pulsed-wave Doppler for mitral valve inflow (287 m/s). The deceleration time decreases with progressive diastolic dysfunction, approaching values <140 m/s. (F) Pulsed-wave Doppler recording on a transthoracic echocardiogram demonstrating forward flow in the pulmonary veins. Note the predominance of diastolic flow (double arrowheads) over systolic flow (single arrowhead). This demonstrates a significant amount of diastolic dysfunction. Also note the wide pulmonary “a” wave (labeled A). Source: ECHOCARDIOGRAPHIC DIAGNOSIS OF CARDIOMYOPATHIES, Critical Care Ultrasonography, 2e Citation: Levitov AB, Mayo PH, Slonim AD. Critical Care Ultrasonography, 2e; 2015 Available at: Accessed: December 27, 2017 Copyright © 2017 McGraw-Hill Education. All rights reserved


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