Transcutaneous doppler jugular venous flow velocity recording.

Transcutaneous bidirectional Doppler jugular venous flow velocity patterns were classified and correlated in 82 patients with right heart hemodynamics. The normal forward flow pattern was biphasic with systolic flow (Sf) greater than the diastolic flow (Df). With rare exceptions, flow patterns of Sf = Df, Sf is less than Df and Df alone indicated abnormal right heart hemodynamics. Abnormal flow patterns (Sf = Df and Sf is less than Df) seen in post cardiac surgery states, and in some rare patients with severe mitral regurgitation despite normal right-sided pressures, were probably secondary to postoperative change in right atrial compliance in the former and to a Bernheim effect in the latter. The most common cause of retrograde systolic flow in the absence of atrioventricular dissociation was tricuspid regurgitation. Persistent retrograde end-diastolic flow with normal forward flow was associated with high right atrial "a" wave pressures, indicating significant decrease in right ventricular compliance with a vigorous atrial contraction. The study clearly established that the jugular venous flow velocity pattern truly reflected derangements in the right heart hemodynamics, irrespective of the underlying etiology. The applicability to bedside evaluation of the jugular venous pulse and the right heart hemodynamics is emphasized.