OP27.03: Evaluation of fetal arrhythmia from simultaneous recordings of pulsed wave Doppler signals in hepatic vein and descending aorta using Dual Doppler

ABSTRACT Dual Doppler echocardiography is a recently developed technique performed using an instrument with two separate sample gates, allowing simultaneous recording of signals from two locations. We describe the use of dual Doppler echocardiography to assess fetal cardiac rhythm. Fetal arrhythmias are common and encountered in 1 to 2% pregnancies. They often resolve spontaneously and do not require treatment, but sometimes lead to severe morbidity and mortality. Fetal arrhythmias are responsive to fetal therapy and require appropriate management through accurate diagnosis. Pulsed wave Doppler and M-mode echocardiography are widely used to assess fetal cardiac rhythm. Both methods have advantages and limitations, which are influenced by fetal position, image resolution, and the complexity of the arrhythmia. We developed a new technique that records pulsed wave Doppler signals in the hepatic vein (HV) and the descending aorta (DAo) simultaneously using dual Doppler. This method is less influenced by fetal position and the complexity of the arrhythmia, and the images have better resolution than those acquired using conventional Doppler methods in most cases. Although, electrical parameters, such as the QT interval cannot be evaluated, dual Doppler recording of flows in HV and DAo is an efficient and effective method for assessing fetal cardiac rhythms, allowing precise diagnosis of cardiac arrhythmias. How to cite this article Kaji T, Maeda K, Hichijo A, Takahashi Y, Nakayama S, Irahara M. Fetal Dual Doppler Echocardiography. Donald School J Ultrasound Obstet Gynecol 2014; 8(4):376-381.

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Abstract 12320: Assessment of Post-Procedural Aortic Regurgitation After Transcatheter Aortic Valve Replacement During the Procedure: An Intraprocedural Transesophageal Echocardiography Study

Circulation ◽

10.1161/circ.130.suppl_2.12320 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Hirotsugu Mihara ◽

Kentaro Shibayama ◽

Hasan Jilaihawi ◽

Yuji Itabashi ◽

Javier Berdejo ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Transesophageal Echocardiography ◽

Aortic Regurgitation ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Color Doppler ◽

Descending Aorta ◽

Transcatheter Aortic Valve ◽

Pulsed Wave Doppler

Introduction: The assessment of post-procedual aortic regurgitation (PAR) after transcatheter aortic valve replacement (TAVR) has not been validated. The purpose of this study was (1) to investigate the value of holodiastolic flow reversal (HDFR) in the descending aorta in patients with PAR after TAVR and (2) to determine which color Doppler parameters are useful for PAR grading using the intraprocedural transesophageal echocardiography (iTEE). Hypothesis: We hypothesized that HDFR in the descending aorta and any color Doppler parameters can delineate significant PAR after TAVR. Methods: Three hundred-eighty patients with severe aortic stenosis underwent TAVR with the Edwards SAPIEN valve with 131 pulsed-wave Doppler tracings from the descending aorta had assessed by iTEE. PAR was evaluated using 2D color Doppler by the cross-sectional area of the vena contracta (VCA) at the aortic annular plane, and by the longitudinal jet extent (mosaic signals, Figure A) compared to the location of the tip of the anterior mitral leaflet (AML). Significant PAR was defined as VCA of ≥10 mm2, corresponding to greater than a moderate grade. Results: In patients with any grade of PAR, pulsed-wave Doppler tracing from the descending aorta, jet extent and VCA were obtained in 100%, 80%, and 74%, respectively. All patients with consistent HDFR had significant PAR. By multivariate analysis, a consistent HDFR and jet extent beyond the tip of AML were independent predictors of significant PAR. A consistent HDFR and jet extent beyond the tip of AML predicted significant PAR with specificity of 100% and 97%, respectively. In the other hand, patients with both negative HDFR and jet extent of less than halfway to the tip of AML had no significant PAR with a 97% specificity. Conclusions: The presence of HDFR with each cardiac cycle and jet extent beyond the tip of AML are indicative of significant PAR.

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