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Lee, Son, Kang, Choue, Kim, Kim, Song, and Bae: Doppler Echocardiography in the Diagnosis and the Estimation of the Severity of the Infundibular Pulmonic Stenosis
Original Article

J Korean Soc Echocardiogr 1994;2(1):61-66.

Published online: 18 February 1994

DOI: https://doi.org/10.3803/jkes.1994.2.1.61

Doppler Echocardiography in the Diagnosis and the Estimation of the Severity of the Infundibular Pulmonic Stenosis

Kyu Nam Lee, M.D., Kyung Hwan Son, M.D., Heung Sun Kang, M.D., Chung Whee Choue, M.D., Kwon Sam Kim, M.D., Myung Shick Kim, M.D., Jung Sang Song, M.D., Jong-Hoa Bae, M.D.

Division of Cardiology, Department of Internal Medicine, School of Medicine, Kyung Hee University, Seoul, Korea

Copyright © 1994 Korean Society of Echocardiography

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

The diagnosis and estimation of severity of infundibular pulmonic stenosis (PS) is difficult by two-dimensional or M-mode echocardiography. In continuous wave(CW) Doppler signal valvular PS is seen as a parabolic velocity profile but infundibular PS is seen as a velocity signal with its peak in late, systole. The purpose of this study is that Doppler echocardiography can discriminate valvular PS from infundibular PS and assess the severity of infundibular obstruction.

Method

Six patients with valvular and infundibular PS by Doppler echocardiography and cardiac catheterization were studied. All had been undergone surgery. We compared their Doppler echocardiographic and cardiac catheterization finding with surgical finding.

Result

1) CW Doppler signal of infundibular PS had lesser peak velocity(2.84m/sec vs 4.33m/scc, p<0.05) and later systolic peak in velocity(AT/ET ratio: 0.73 vs 0.51, p<0.05) than that of valvular PS.
2) Pressure gradient across the infundibular obstruction measured by Doppler echocardiography correlated well with that by cardiac catheterization(r=0.89, p<0.05).
3) Operation finding showed infundibular PS in 5 case but not one and coexisting other anomaly such as ASD in 4 case, TOF in 1 case, PAPVR in 1 case.

Conclusion

Doppler echocardiography is a useful noninvasive method for the diagnosis and the estimation of severity of infundibular obstruction in patient with PS.

Keywords: Doppler echocardiography, Infundibular pulmonic stenosis, Valvular PS.

References

1). Weyman AE. Principles and Practice of Echocardiography. 2nd Ed. p. 885. Philadelphia: Lea and Febiger;1994.
2). Wilde P. Cardiac ultrasound. p. 95. New York: Churchill Livingstone;1993.
3). Feigenbaum H. Echocardiography. 5th Ed. p. 361. Philadelphia: Lea and Febiger;1994.
4). Carlos OL, David JS, Lilliam MV, Stanley JG, Jesus VB, Hugh DA, Ehud G. Noninvasive prediction of transvalvular pressure gradient in patients with pulmonary stenosis by quantitative Two-dimensional echocardiographic Doppler studies. Circulation. 67:866–871. 1983.
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6). Silove ED, Giovanni JV, Shiu MF, Myint MY. Diagnosis of right ventricular outflow obstruction in infants by cross sectional echocardiography. Br Heart J. 50:416–20. 1983.
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7). Houston AB, Simpson IA, Sheldon CD, Doig WB, Coleman EN. Doppler ultrasound in the estimation of the severity of pulmonary infundibular stenosis in infants and children. Br Heart J. 55:381–4. 1986.
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8). Peter M, Carla W, David R, Graham L, Ernest C, Aubrey L. Non-invasive diagnosis of subpulmonary outflow tract obstruction. Br Heart J. 43:276–283. 1980.
9). Weyman AE, Dillon JC, Feigenbaum H, Chang S. Echocardiographic differentiation of infundibular from valvular pulmonary stenosis. Am J Cardiol. 36:21–6. 1975.
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10). Teiretein PS, Yock PG, Popp RL. The accuracy of Doppler ultrasound measurement of pressure gradients across irregular, dual, and tunnellike obstruction to blood flow. Circulation. 72:577–584. 1985.
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Fig. 1.
Continuous wave Doppler signal of valvular and infundibular pulmonic stenosis. Left signal shows a parabolic flow velocity signal of valvular PS superimposed by infundibular PS in which a peak velocity occurs in late systole. Right signal shows only infundibular PS.
AT: Acceleration time, ET: Ejection time
jkse-2-61f1.tif
Fig. 2.
Cardiac catheterization reveals infundibular pressure in same patient that Doppler finding was seen in Fig. 1.
PA: pulmonary artery, INF: infundibulum.
RV: right ventricle
jkse-2-61f2.tif
Fig. 3.
Comparison of infundibular pressure gradient by doppler echocardiography and catheterization.
jkse-2-61f3.tif
Table 1.
Comparison of doppler velocity spectrum in valvular and infundibular PS
  Valvular PS Infundibular PS
Peak velocity(m/sec) 4.33 2.84∗
AT/ET 0.51 0.73∗

AT: Acceleration time, ET: Ejection time

∗ p<0.05

Table 2.
Doppler, catheterization and operation findings of study patients
Patients Peak velocity (m/sec) Pressure (mmHg) Op.finding
  V I PA INF RV  
1. 5.0 3.9 12 120 150 ASD, PS(V, I)
2. 5.0 1.8 20 50 105 ASD, PS(V)
3. 4.4 2.8 20 56 105 PS(V, I)
4. 3.4 2.3 20 52 106 PS(V, I)
5. 3.8 3.4 20 70 110 TOF, ASD, PS(V,I)
6. 4.3 2.8 15 55 70 ASD, PAPVR, PS(V, I)

V: Valvular PS, I: Infundibular PS, PA: Pulmonary artery INF: Infundibulum, RV: Right ventricle

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