Pulsed Doppler Echocardiographic Description of a Circular Flow Pattern in Spontaneous Left Ventricular Contrast

Pulsed Doppler echocardiography was performed in nine patients with spontaneous intracavitary dynamic echoes, revealing a circular flow pattern. All patients had a severely dilated left ventricle as a result of ischemic heart disease. The sample volume was placed in the apical four-chamber view near the lateral wall and near the interventricular septum, halfway between the mitral valve anulus and apex. A continuous (i.e., during both systole and diastole) positive signal was recorded near the lateral wall and a continuous negative signal at the interventricular septum. This indicates flow continuously toward the transducer along the lateral wall and away from the transducer along the interventricular septum. This is consistent with the circular flow pattern, as demonstrated by the spontaneous intracavitary dynamic echoes. In 22 normal volunteers a positive prominent shift was recorded during diastole near the lateral wall and either a negative (nine of 22) or no (13 of 22) shift at all during systole. Near the interventricular septum a negative systolic shift followed by a positive, early-diastolic shift was consistently recorded. In the large majority (18 of 22) negative waves were recorded during middle and late diastole. A continuous positive or negative Doppler signal was consistently absent in healthy subjects. The angle between the proximal part of the interventricular septum and the anterior mitral valve leaflet during maximal early diastolic opening in the patients was 74 +/- 4.8 degrees (mean +/- SD), which may give rise to a preferential eccentric inflow and the maintenance of the circular apical flow pattern.