DK2985_C000 1..28 - AlSharqia Echo Club

258 Transesophageal EchocardiographyTable 11.1Doppler Criteria for Constrictive PericarditisMethodVariableCriteriafor CPSpecificity(%)Sensitivity(%)Mitral Doppler Resp. variation in peak E 10% 84 91Pulmonary vein Doppler Resp. variation in peak D 18% 79 91Tissue Doppler Peak E m 8cm/sec 89 100Color M-mode Slope of first alias 100 cm/sec 74 91Note: CP, constrictive pericarditis; Resp., respiratory.Source: Adapted from Rajagopalan et al. (12).will be preserved (.8.0 cm/sec) in constrictive pericarditis(Fig. 11.19). The Doppler myocardial velocity gradient(MVG) measured from the LV posterior wall also helps todiscriminate RCMP from CP. Indeed, the MVG isdecreased in RCM patients compared with both normaland CP patients during ventricular ejection and rapid ventricularfilling (11). During isovolumic relaxation, theMVG is positive in RCMP and negative in both normaland CP patients. 5—Color M-mode flow propagation ofleft ventricular filling: a slope 100 cm/sec for the firstaliasing contour in color M-mode flow propagation ofleft ventricular filling can predict patients with CP, whileit is typically reduced ,45 cm/sec in RCMP (12).An algorithm that incorporates mitral inflow Dopplersignal and tissue Doppler has been proposed todifferentiate constriction from restrictive cardiomyopathyand normal physiology (13) (Fig. 11.22). The sensitivityand specificity of the different Doppler criteria for CPare shown in Table 11.1 (12).IV.PERICARDIAL CYSTPericardial cysts are uncommon intrathoracic lesions andare typically located in the right cardiophrenic angles onchest X-ray. Transthoracic echocardiography will reveala spherical cystic echo-free space contiguous to theheart. Usually, they are associated with an excellentlong-term prognosis and are often detected incidentally,but complicated clinical courses, including sudden death,(A)(B)PERICARDIALCYSTRPALPAAoRAPA(C)(D)PERICARDIALCYSTLALSPVLAALVFigure 11.23 (A, B) Upper esophageal view at 08 showing a round hypodense mass consisting of a pericardial cyst compressing theposterior wall of the right pulmonary artery (RPA) in a 29-year-old man with retrosternal chest pain. (C, D) In a 36-year-old-man consultingfor dyspnea, a mid-esophageal two-chamber view reveals a pericardial cyst compressing the left atrium (Ao, aorta; LA, left atrium;LAA, left atrial appendage; LPA, left pulmonary artery; LSPV, left superior pulmonary vein; LV, left ventricle; PA, pulmonary artery;PT, pulmonary trunk; RA, right atrium). [Adapted from Antonini-Canterin et al. (15).]