The Relationship of Pulmonary Valve Motion to the Motion of Surrounding Cardiac Structures: A Two-dimensional and Dual M-mode Echocardiographic Study

SUMMARY To assess the relationship of late diastolic pulmonary valve motion to motion of adjacent car-diac structures, we performed two-dimensional and dual M-mode echocardiography on 15 pulmonary normo-tensive (group A) and nine pulmonary hypertensive subjects (group B). Simultaneous pulmonary valve and posterior aortic wall a-waves were less prominent in group B than in group A (p < 0.001), and their amplitudes were linearly related within each group (r = 0.83). Analysis of two-dimensional studies confirmed a relation-ship between pulmonary valve and posterior aortic wall late diastolic motion. No subject had independent pre-systolic motion of the pulmonary valve within the pulmonary artery. Subjects with shallow a-waves had im-paired left atrial emptying compared with those with normal a-wave amplitudes (p < 0.01). We conclude that the pulmonary valve a-wave does not represent independent valvular displacement, but rather, reflects motion of the entire cardiac base. Variations in a-wave morphology may result, at least in part, from the effects of altered ventricular geometry and compliance on left atrial emptying. THE DIASTOLIC WAVE FORM of the pulmonary valve echocardiogram includes a presystolic a-wave of uncertain origin and physiologic significance. Investi-gators disagree as to the relative contributions o