A. The continuous-wave Doppler tracing of the right ventricular outflow
tract obtained from the right parasternal short axis position showed
diastolic pulmonary insufficiency (positive waves, PI) beginning after
the T wave (red arrow) and ending during the isovolumic contraction period (blue
arrow).
B. The prolongation of pulmonary insufficiency (PI) during isovolumic contraction (blue
arrow) was confirmed by color-flow Doppler from the right
parasternal short axis position. Blood flow (red color) is directed
toward the transducer into the right ventricular outflow tract.
C. Continuous-wave Doppler examination performed from the left apical 4-chamber
view identifying a marked tricuspid insufficiency (negative waves, TI) beginning
during the isovolumic contraction phase (blue arrow), continuing
during systole and isovolumic relaxation, and ending in
the middle of P wave (green arrow). A late diastolic negative signal
occurring after the P wave onset can also be seen (yellow arrows). This
may arise from diastolic tricuspid regurgitation or from reversal of
flow (A reversal) in the caudal vena cava.
D. Prolongation of the tricuspid insufficiency (TI) during early electrical
diastole was confirmed using color-flow Doppler mode, frame taken
between the end of T wave and the beginning of P wave (green arrow). The
large turbulent jet of TI extends from the right ventricle to the
dorsal wall of the severely enlarged right atrium.
RA — Right atrium; RV — Right ventricle; Ao — Aorta; PT — Pulmonary trunk