Final The Echo Manual DIGITAL

Chapter 12 Pericardial Diseases

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FIGURE 12-33 A: Mitral inflow velocities ( left ) and hepatic venous flow velocities ( right ) from pure tamponade ( A , B ), effusive constrictive ( C , D ), and constrictive pericarditis ( E , F ). Mitral and hepatic vein pulsed-wave Doppler findings in the effusive tampon- ade, effusive-constrictive pericarditis, and constrictive pericarditis. Mitral pulsed-wave wave Doppler shows low inspiratory and expiratory E/A ratios in a patient with pure tamponade ( Panel A ). There are marked expiratory diastolic flow reversals ( DR ) in the hepatic veins ( panel B ) with no diastolic forward flow. Note the predominance of early diastolic flow in the patient with effusive constrictive pericarditis ( panel C ) but with lower E/A ratios and longer deceleration times compared to CP ( panel E ). Hepatic diastolic forward flow is still markedly diminished in effusive constrictive pericarditis ( panel D ) but not totally absent, in contrast to the deep diastolic ( D ) waves seen in CP. B: Schematic diagrams of mitral annulus velocities, mitral inflow and hepatic vein velocities in pure tamponade, effusive constrictive pericarditis, and chronic constric- tive pericarditis. S , systolic flow. (W. Miranda et al. Submitted.)

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