[Hepatic vein blood flow pattern measured by Doppler echocardiography as an evaluation of tricuspid valve insufficiency].

Evaluation of tricuspid regurgitation was attempted by analyzing the blood flow pattern in the hepatic vein using a combined system of a pulsed Doppler technique and two-dimensional echocardiography. The Doppler incident angle to the hepatic vein from the subcostal approach was approximately 0 degrees to 30 degrees, and the Doppler output was easily recognized as a narrow frequency-band pattern on the sound spectrogram. The study population consisted of 60 patients with valvular heart disease and 17 healthy subjects. Inferior vena cava dimension (IVCD), hepatic vein dimension (HVD) and the blood flow pattern in the hepatic vein were compared with the severity (negative, mild, moderate and severe) of tricuspid regurgitation (TR) assessed by right ventriculography and with right atrial and ventricular pressures. The following conclusions were derived from the study: IVCD and HVD in a group of TR severe were significantly larger than those of the other groups. The normal flow pattern of the hepatic vein was biphasic with a systolic flow greater than a diastolic flow. In cases of valvular heart disease with atrial fibrillation, three types of abnormal blood flow patterns were demonstrated; Type 1 had a slower systolic flow than a diastolic flow. Type 2 had no flow signal during systole, and had only a diastolic flow. Type 3 had a reversed systolic flow with several variations. By this hepatic flow patterns, it was possible to differentiate the TR of severe and moderate groups from the TR of mild group, because 81% of the former groups showed a Type 3 of a flow pattern. The Doppler shifts from the base line on the sound spectrogram were well correlated with right atrial pressure and right ventricular end-diastolic pressure (r = -0.72 and -0.64, respectively). The early changes of the hepatic blood flow pattern after operation were due to the improvement of TR by tricuspid annuloplasty, and also seemed to be affected by the postoperative changes of right atrial compliance and contraction.