PERSISTENCE OF NORMAL RIGHT-VENTRICULAR DOPPLER FILLING PATTERN EARLYAFTER TRICUSPID-VALVE EXCISION

Two patients with acute tricuspid bacterial endocarditis in which a no rmal right ventricular Doppler filling pattern was demonstrated early following valvectomy are reported. After surgery, on pulsed Doppler ex amination, the sample volume positioned at the right atrioventricular level revealed a normal M-shaped filling pattern. A pathologic monopha sic pattern was documented a few months later. Our findings suggest th at early after surgery the preserved gradient throughout ventricular d iastole leads to a passive and active filling similar to normal. Only at a later stage is the grossly dilated right atrium unable to maintai n active filling, and the 'A' wave disappears despite the fact that si nus rhythm is maintained. Tricuspid valve diastolic motion represents a product of the several factors that determine atrioventricular gradi ent, but the valve itself appears not to be involved in the generation of a normal filling pattern.