Echocardiographic patterns of pulmonic valve motion with pulmonary hypertension

Echocardiographic tracings of the pulmonic valve were examined in two groups of patients. The first group contained 24 normal patients. The second group consisted of 32 patients with pulmonary hypertension (mean pulmonary artery pressure ≥20 mm Hg). Parameters considered included presence or absence and depth of the "a" wave, amplitude of valve opening (b-c separation), diastolic (e-f) slope, and presence or absence of mid-systolic closure or fluttering of the pulmonic leaflet. An "a" wave was present in all 24 normal subjects. The "a" wave varied with respiration and the maximum "a" wave depth (A Max) averaged 3.7 ± 1.2 mm (mean ± sd , range 2-7 mm). A Max was ≥2 mm in all 24 normal patients. In 19 of 24 patients with pulmonary hypertension and sinus rhythm no "a" wave was present. In the other five patients small "a" waves (≤2 mm) occurred. In four of these five patients, right heart failure was present. The diastolic (e-f) slope averaged 36.9 ± 25.4 mm/sec (range 6-115 mm/sec) in normals. With pulmonary hypertension, this slope was significantly less than normal (average 5.2 ± 8.9 mm/sec, range –9 to +30 mm/sec, P < .001). In six patients with pulmonary hypertension a negative e-f slope was seen; this never occurred in normals. Mid-systolic closure or notching of the systolic (c-d) segment occurred in 18 of 20 subjects with pulmonary hypertension in whom the leaflet was clearly recorded in mid-systole. This finding was not observed in normals. Likewise, mid-systolic fluttering was present in 22 of 24 patients with pulmonary hypertension. There was no difference in amplitude of leaflet opening between the two groups.