Final The Echo Manual DIGITAL

The Echo Manual

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CHAPTER 12 PERICARDIAL DISEASES

recordings, especially with slower or less irregular atrial fibrillation (Fig. 12-27A). Hepatic vein dia- stolic flow reversal with expiration should remain present with constrictive pericarditis, even when the mitral inflow velocity pattern is not diagnostic. Occasionally, it becomes necessary to regularize the patient’s rhythm with a temporary pacemaker or a cardioversion to evaluate the respiratory variation in Doppler velocities (Fig. 12-27A). Furthermore, tis- sue Doppler medial mitral annulus e ′ remains exag- gerated, and the lateral e ′ is lower in these patients (Fig. 12-27C), which are also reflected in the strain imaging (Fig. 12-27). Respirophasic abnormal ven- tricular septal motion will be present in constriction regardless of rhythm. Mayo Clinic diagnostic crite- ria still hold well for constriction patients with atrial fibrillation (26).

FIGURE 12-26 Mitral inflow velocity in a patient who developed constriction after mitral valve replacement. Note the typical respiratory variation in mitral E ( single arrow ) velocity. Deceleration time is shortened despite the presence of a mechanical mitral prosthesis because of increased left atrial pressure. Arrowhead , closing of the mitral prosthesis; double arrows , opening click of the mitral prosthesis; A , atrial filling; Exp , expiration; Insp , inspiration.

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FIGURE 12-27 A: Mitral inflow, hepatic vein, and mitral annulus tissue Doppler recording from a patient with constriction and atrial fibrillation. We use the same criteria for diagnosing constriction in atrial fibrillation as in sinus rhythm with minor exceptions. It is often difficult to use respiratory variation of mitral inflow velocity in atrial fibrillation, but this patient shows high E velocity with mild respiratory variation ( upper left ). Hepatic vein may not demonstrate dia- stolic flow reversal with short cycle length, and instead, there are expiratory systolic flow reversals ( arrows in upper right ). Mitral annulus e ′ ’ velocity fre- quently shows “Annulus Reversus” with a medial e ′ of 10 cm/sec and a lateral e ′ of 8 cm/s as in this patient ( bottom ).

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