[Transesophageal echocardiography (Part 2): Basic concepts in Doppler techniques].

Cardiac Doppler techniques provide information on blood flow dynamics by applying Doppler frequency shift analysis to echo signals from moving red blood cells. Velocity and direction of blood flow can be determined and instantaneously displayed on a monitor screen. These techniques include pulsed-wave Doppler (PWD), continuous wave Doppler (CWD) and color Doppler imaging (CDI). In PWD, short bursts of ultrasound waves are emitted at a pulse-repetition frequency (PRF), and velocity and direction of blood flow can be measured at specific locations in the heart. This technique enables measurement with high spatial resolution. By its nature as a sampling system, however, PWD can not accurately measure Doppler shift frequency exceeding the Nyquist limit (PRF/2). In CWD, ultrasound pulses are continuously emitted and received by two separate transducers. Precise localization of a sampling volume is impossible in this technique, but CWD can determine higher flow velocity without ambiguity than that detected by PWD. CWD is useful to evaluate high-velocity blood flows such as those seen with valvular diseases or shunt lesions. CDI displays two-dimensional patterns of blood flow in colors, superimposed on the two-dimensional images of the heart structures. Thus, the velocity, direction and location of blood flows can be visualized in real-time. This technique facilitates detection of abnormal blood flows in the heart and major blood vessels, and it is also utilized to evaluate the severity of valvular regurgitation.