intracardiac shunts and role of tissue doppler imaging in diagnosis and discrimination

background: we sought to assess right ventricular (rv) systolic and diastolic functions via tissue doppler imaging (tdi) in order to discriminate right-to-left (bidirectional) from left-to-right intracardiac shunts. methods: a tissue doppler velocity study via doppler echocardiography was performed in 20 patients with left-to-right shunt (without evidence of significant pulmonary hypertension) and 20 patients with right-to-left shunt or bidirectional shunt (with significant pulmonary hypertension) or eisenmenger΄s complex and 20 healthy subjects as the control group. rv myocardial performance index (mpi), s wave velocity, e wave velocity, isovolumic relaxation time (ivrt), and isovolumic contraction time (ivct) from the lateral tricuspid annulus were measured using tdi. results: in the patients with left-to-right shunt, the tissue doppler parameters showed higher s- wave, peak systolic(sa)/early contraction(ea) , sa/ivrt, and sa/ivct values; and in the patients with right-to-left or bidirectional shunt tissue, the doppler parameters showed higher mpi and mpi/sa value with a high specificity and sensitivity. conclusion: we conclude that an evaluation of mpi, s wave, e wave, ivrt, and ivct via tissue doppler echocardiography is a useful index for the discrimination of right-to-left from left-to-right and bidirectional intracardiac shunts.