VP23.07: Evaluation of fetal arrhythmias from simultaneous pulsed‐wave Doppler signals in hepatic vein and descending aorta using dual‐gate 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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P1830 Single-beat aortic arch pulse wave velocity by dual-gate simultaneous Doppler technique: a novel method for arterial stiffness evaluation

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.1173 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

F Antonini-Canterin ◽

A Pepe ◽

M Strazzanti ◽

D Rivaben ◽

E Nicolosi ◽

...

Keyword(s):

Pulse Wave Velocity ◽

Healthy Volunteers ◽

Aortic Arch ◽

Wave Velocity ◽

Aortic Stiffness ◽

Pulse Wave ◽

Surrogate Marker ◽

Mri Studies ◽

Pulsed Wave Doppler ◽

Dual Gate

Abstract Background Guidelines recommend increased aortic stiffness as a negative prognostic factor to be considered in primary and secondary prevention. Pulse wave velocity (PWV) is a frequently employed surrogate marker of aortic stiffness. Carotid-femoral PWV is the most common index in research and clinical practice, but recently several velocity-encoded magnetic resonance imaging (MRI) techniques have been used for the evaluation of regional aortic arch PWV, where the stiffness seems to be particularly relevant from a prognostic point of view. Purposes. We developed a new ultrasound method for the assessment of aortic arch PWV, using a single-beat dual-gate simultaneous pulsed wave Doppler tracing. The aim of the study is to evaluate the feasibility of this new technique in a group of healthy volunteers. Methods We examined 126 healthy volunteers (81 females, 45 males, mean age 42 + 15 years, range 13-83 years) using a commercially available machine equipped with simultaneous dual-gate pulsed Doppler. Using the suprasternal approach, the first sample volume was placed in ascending aorta and the second one in descending aorta. The distance between the two sites was directly measured with a curvilinear tracing in the middle of the vessel, following the shape of the aortic arch. PWV was calculated as the ratio of distance (in millimiters) and the transit time (in milliseconds) measured using the "foot-to-foot" method. The results are then easily transformed, simplifying in the commonly unit of meters/second. Results Feasibility was 99%; in one case it was not possible to measure accurately the aortic arch PWV due to unfavorable suprasternal acustic window. The procedure time was very fast, requiring 2 + 1 minutes. Intraobserver and interobserver variability were 7% and 9% respectively. Aortic arch PWV, as expected, showed a strong correlation with age in males as well as in females (r= 0.71 and r = 0.60 respectively, p < 0.001 for both); there was also a significant correlation with body mass index (r = 0.31; p < 0.001). Aortic arch PWV values ranged from 3.1 to 8.5 m/s, showing a substantial overlap with normal values reported in MRI studies. Conclusions The direct measurement of aortic arch PWV is feasible and reproducible with ultrasound, using the novel single-beat dual-gate simultaneous pulsed wave Doppler tracing. This technique could be implemented in a standard echo examination, that is much more available than MRI studies. Further studies are needed to evaluate if Doppler-derived aortic arch PWV could provide additional prognostic information. Abstract P1830 Figure. Aortic Arch PWV

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