A DIFFICULT SPECTRAL TISSULAR DOPPLER
DIFFICULT SPECTRAL TISSULAR DOPPLER? NOT REALLY.
PRESENTED TISSULAR DOPPLER
MAIN DIAGNOSTIC OBSERVATION
Notice the postero lateral basal wall (first picture). Almost in continuity with the end of A’ wave, there is a marked positive wave during the pre ejection period (arrow) but before the isovolumic contraction time. It is not present in the postero basal IVS (arrow in the second picture). Usually here, at this moment, there is a peak pre ejection wave considered to be the closing of the tricuspid valve but really seems to be a rebound of the A’ wave. This clearly indicates an accessory pathway at the posterolateral basal wall. WPW type A.
NOW WITH THE ECG. NO FUN!
Is it clear now? Look at the Delta wave.
What about this notch at the IVS E’ wave?
To me it is related to the same findings seen at the walls and mainly at IVS in M mode (M-Mode is not dead). There is an early relaxation of the initial contracting segments, and during its late phase, when almost finishing , some late contracting segments may still have a small appearance producing this bump in the IVS and inferior wall that occurs simultaneously with the E’ wave notch of the IVS. It is just an educated guess.
As seen in a picture of Morcerf’s “Ecocardiografia Uni-Bidimensional Transesofágica e Doppler”
Small arrow = early contraction. Large arrows= late contraction appearing when the early relaxation finishes.