Detection of Diastolic Atrioventricular Valvular Regurgitation by Color Doppler Flow Mapping

Color Doppler provides noninvasive evaluation of blood flow through cardiac valves, and has been shown to be sensitive in the detection of valvular regurgitation. We studied 10 consecutive patients, all with complete heart block. Ten individuals with a normal PR interval served as control subjects. AU patients with A-V (Atrio-ventricle) block had color Doppler evidence of a mild degree of diastolic mitral regurgitation or tricuspid regurgitation. Precise timing and duration of diastolic mitral or tricuspid regurgitation was confirmed by color M-mode and pulsed Doppler and diastolic tricuspid regurgitation was found in 7 of these. Diastolic mitral regurgitation was detected in all 10 patients with A-V block. One patient underwent diagnostic cardiac catheterization with simultaneous recording of left ventricular and pulmonary wedge pressure. A reversal in the AV gradient of 2 mmHg was seen during the ”a” wave of the ventricular pressure wave. In conclusion: 1) diastolic mitral or tricuspid regurgitation is mild in degree. 2) In diastolic mitral regurgitation, LVEDP (left ventricle end-diastolic pressure) is higher than LAEDP (left atrium end-diastolic pressure) diastolic AV valve regurgitation is physiologic in nature and not due to structural heart disease.