Journal of The Indian Academy of Echocardiography & Cardiovascular Imaging

DOPPLER QUIZ
Year
: 2020  |  Volume : 4  |  Issue : 3  |  Page : 378--379

Doppler Basics


Satish K Parashar 
 Department of Cardiology, Noninvasive Cardiac Laboratory, Metro Hospital and Heart Institute, New Delhi, India

Correspondence Address:
Prof. Satish K Parashar
Noninvasive Cardiac Laboratory, Metro Hospital and Heart Institute, New Delhi
India




How to cite this article:
Parashar SK. Doppler Basics.J Indian Acad Echocardiogr Cardiovasc Imaging 2020;4:378-379


How to cite this URL:
Parashar SK. Doppler Basics. J Indian Acad Echocardiogr Cardiovasc Imaging [serial online] 2020 [cited 2021 Feb 25 ];4:378-379
Available from: https://www.jiaecho.org/text.asp?2020/4/3/378/303932


Full Text

A 44-year-old woman was referred for echocardiography on the day of discharge following a normal coronary angiography. The obtained pulsed Doppler recording is shown in [Figure 1]. Electrocardiogram (ECG) is shown in [Figure 2].{Figure 1}{Figure 2}

What is the diagnosis and mechanism?.

 View Answer

 Doppler Diagnosis



The diagnosis, guided by ECG, was typical of a “lobster claw” pattern. This is found in apical hypertrophic cardiomyopathy especially in association with mid-ventricular obstruction.[1] The late systolic intraventricular gradient is a result of the opposing hypertrophied left ventricular (LV) walls, creating a narrow, hourglass-shaped ventricular cavity.[2] The intracavitary diastolic gradient as seen in the Doppler figure is due to two factors: (a) blood may become entrapped under pressure in the apical cavity during ventricular systole and is able to empty out during relaxation, creating a small early diastolic gradient and (b) an impaired and delayed apical diastole, resulting in transiently higher pressures in the apex during diastole.[3] The paradoxical jet flow in this patient, during diastole, was directed toward the base away from the apex, hence a negative Doppler shift. The timing of apical gradients is earlier than that of LV outflow tract (LVOT) diastolic gradients that occur when the anterior mitral leaflet contacts the septum, creating flow restriction into the LVOT.

These gradients can be quite high and need to be differentiated from LVOT gradients related to residual systolic anterior motion (SAM) postmyectomy. Failure to distinguish an intracavitary gradient from the one generated by SAM-septal contact might prompt the surgeon toward a more extensive septal resection, risking an iatrogenic ventricular septal defect.

The upright diagrammatic representation of the lobster claw pattern is shown in [Figure 3], which resembles the Doppler signal of this patient.{Figure 3}

The corresponding echo pictures are shown in [Figure 4] and [Figure 5].{Figure 4}{Figure 5}

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Ioannides MA, Konis P, Georgiou G, Nicolaides E. Diastolic gradient in hypertrophic cardiomyopathy of the apical type. Eur J Echocardiogr 2004;5:79-81.
2Maron MS, Finley JJ, Bos JM, Hauser TH, Manning WJ, Haas TS, et al. Prevalence, clinical significance, and natural history of left ventricular apical aneurysms in hypertrophic cardiomyopathy. Circulation. 2008;118:1541-9.
3Elsayes AH, Joshi B, Maron MS. A case of multiple ventricular gradients. J Cardiothoracic Vascular Anesthesia 2018;32:1829-32.