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THIS article, the third and final instalment in a series on the role of Doppler ultrasonography in the
investigation of diseases in dogs and cats, discusses the applications of Doppler ultrasound in the
assessment of cardiac diseases. The previous articles described the Doppler principle and the different
Doppler techniques used for diagnosis (Part 1, In Practice, April 2005, pp 183-189) and the applications
of Doppler ultrasound in the abdomen (Part 2, May 2005, pp 238-247).
Quantitative assessment ++ + + – _
of blood flow
Global view of blood flow – – ++ ++ _
within an organ
Assessment of ventricular _ _ _ _ ++
wall motion
– Not used, + Moderately useful, ++ Optimal method
Valve to be
interrogated Optimal transducer location
Mitral valve Mitral inflow and insufficiency are best imaged from the
left apical four-chamber view
Pulmonic valve The optimum view is either the right parasternal short-axis
view at the level of the heart base or, in some cases, the
Doppler spectrum obtained from the pulmonary artery of a dog using a
left cranial parasternal long-axis view
continuous wave technique at 2·5 MHz. The vertical axis is Doppler shift in
kHz: positive shifts (increase in apparent frequency) represent flow towards
the transducer and negative shifts represent flow away from the transducer. Aortic valve The highest (and therefore most accurate) velocities are
The horizontal axis is time in seconds (with subdivisions every 0·2 seconds). usually obtained from the subcostal view. However, this
An ECG (green line) is used to determine the stage of the cardiac cycle. is difficult to achieve in some dogs and most cats. The left
There is high velocity systolic flow away from the transducer (1 to 3), which apical ‘five-chamber’ view can be used under these
represents the forward stroke volume, and lower velocity diastolic flow circumstances
towards the transducer (4), which is the result of pulmonic insufficiency
P1 – P2 = 4v2
The appearance of the Doppler spectrum varies according to the type of blood flow. (A) In the ascending aorta there is normally plug flow, in which all the
RBCs accelerate and decelerate together, so the Doppler spectrum is a line with a lack of signal (*) beneath it. This type of pattern will only be seen using
pulsed wave Doppler where the sample volume is relatively small. (B) In vessels containing disturbed flow (eg, as a result of stenosis), the Doppler spectrum
will show an increased peak systolic velocity (large arrow) and a signal below the baseline (small arrow), which occurs because of turbulence. In this
example, the late peak in velocity and shape of the velocity trace suggest that the peak velocity, and therefore greatest pressure gradient, develops in
late systole; this indicates the presence of a dynamic stenosis, as can be seen in cases of hypertrophic obstructive cardiomyopathy
Mitral valve
Flow across the mitral valve should be diastolic. It typical-
Normal pattern Delayed relaxation Restrictive filling
ly occurs in two phases: the early filling, or E wave, and
The normal pattern Delayed relaxation of A restrictive
the late filling secondary to atrial contraction, or A wave.
of flow is characterised the myocardium leads filling pattern is
The relative magnitude and duration of these waves can be
by a relatively rapid to a reduction in the characterised by
used to characterise diastolic function of the left ventricle.
acceleration of blood magnitude of the the majority of the
Mitral stenosis is a relatively rare congenital condition
into the left ventricle E wave, more gradual ventricular filling
in which the mitral inflow velocities may alter in their mag-
during passive deceleration of flow occurring during
nitude or duration (see box on the left and image below).
ventricular filling to and thus prolongation early diastole. The
a peak inflow velocity, of the slope. E wave is increased
followed by a relatively Atrial contraction in magnitude but
rapid deceleration. contributes a relatively decreased in duration.
This gives rise to greater proportion of The A wave is
the E wave. Atrial ventricular filling – relatively decreased
contraction then therefore, the A wave in magnitude.
produces a second may be greater in
peak of inflow (A magnitude than the
wave). The magnitude E wave. Prolongation
Mitral stenosis in a young dog. This pulsed wave Doppler
of the peak velocity of of the slope is also spectrum shows the characteristic biphasic inflow velocities
the A wave should be seen with narrowing consisting of the E wave (E) and A wave (A). In this instance,
there is prolonged deceleration of the E wave, which
less than that of the of the mitral valve or
indicates delayed equilibration of atrial and ventricular
E wave. mitral stenosis. pressures in diastole. In combination with other clinical
and echocardiographic findings, this appearance supports
a diagnosis of mitral stenosis
Blood
Blood
Low amplitude
filter
Velocity
Low velocity filter Velocity
(A) (B)
(C)
DOPPLER TISSUE IMAGING in the cardiac cycle and, in some cases, to characterise
systolic and diastolic function of the myocardium. The
As discussed in this series of articles, Doppler ultrasound major application of this technique is assessment of
is used mostly to detect echoes from RBCs, which are myocardial infarction in human patients, but it may also
very weak compared with echoes from tissue. Weak prove to be useful in the assessment of dogs and cats with
echoes from blood – particularly in small or deeply situ- cardiomyopathy.
ated blood vessels – may be boosted by administering
Further reading
an intravenous ultrasound contrast medium containing A detailed description of the various techniques of cardiac Doppler
microbubbles, which are strong reflectors of ultrasound. examination is outside the scope of this article. Interested readers
are referred to the following texts for further information:
It is also possible to measure the Doppler shift of echoes GOLDBERG, S. J., ALLEN, H. D., MARX, G. R. & DONNERSTEIN, R. L.
returning from moving tissues, such as the myocardium. (1988) Doppler Echocardiography, 2nd edn. Philadelphia, Lea &
Febiger
Doppler tissue imaging uses a filter to remove the rela- MARCUS, M. L., SCHELBERT, H. R., SKORTON, D. J. & WOLF, G. L.
tively weak echoes from flowing blood (as illustrated (1996) Cardiac Imaging; A Companion to Braunwald’s Heart
Disease, 2nd edn. Philadelphia, W. B. Saunders
above). This specialised technique is used to measure the NYLAND, T. G. & MATTOON, J. S. (2001) Veterinary Diagnostic
timing, magnitude and direction of myocardial movement Ultrasound, 2nd edn. Philadelphia, W. B. Saunders