[Pulsed echo-Doppler diagnosis and evaluation of tricuspid valve, and interventricular and interatrial communication insufficiencies. Flowmeter study of shunts].

A group of 44 patients with a total of 48 cardiac lesions ( 22 tricuspid incompetence - TI - , 12 ventricular septal defect - VSD - and 14 atrial septal defect - ASD - , and two control groups of 20 normals and 23 patients with other cardiac disease , were studied by pulsed Doppler echocardiography ( PDE ) . The flow patterns recorded in the normal right heart were identical to those recorded previously during catheterisation . TI was diagnosed by the presence of an abnormal negative systolic wave usually associated with widening of the time interval histogram with a specificity of 82 % and a sensitivity of 86 % . An acceptable semi-quantative assessment of the severity of regurgitation was obtained in 83 % by comparing the amplitude of the negative systolic wave with that of the positive diastolic wave . Shunts were diagnosed by detecting septal or tricuspid turbulence with a sensitivity of 83 % and a specificity of 90 % . A satisfactory assessment of the size of the shunt was obtained in 90 % of diagnosed cases by assessing the pulmonary and infundibular flow patterns . A systolic wave starting with isometric contractions , followed by positive early and late diastolic waves and some intermediary negative oscillations of variable amplitude were recorded along the right side of the interventricular septum in 75 % of VSDs . In 78 % cases of ASD a large late systolic - early diastolic wave overriding the second heart sound , followed by positive mid and late diastolic waves of variable size , according to the heart rate , were recorded in the right atrium . In conclusion , PDE recording of blood flow patterns and turbulence in the right heart is a useful non-invasive method of diagnosis and assessment of these three cardiac lesions . It provides a valuable contribution towards the physiopathological study of shunt patterns in atrial and ventricular septal defects .