Echocardiogram of the pulmonary valve was obtained in 31 normal subjects to examine the effects of atrial contraction on the valve motion.In normal echograms, the mid to late diastolic slope was 5.7 mm/sec (range: 0-18), the depth of 'a' wave 3.5 mm (2-6), opening slope 297 mm/sec (190-460), and right-sided pre-ejection period (RPEP) 92 msec (70-120). The RPEP was not influenced by the heart rate. The 'a' wave width showed good correlation (r=0.81) with the PQ interval, though the latter was longer than the former. There was no statistically significant difference in the width and amplitude of the 'a' wave between aortic and pulmonary valve echoes during expiratory apnea. Typical respiratory change of the normal pulmonary valve echo was such that, during inspiration, the 'a' wave became exaggerated and caused a presystolic opening, although the degree of the change in individual cases was variable. It was concluded: 1) the pulmonary valve echogram had the remarkable variation from presystolic opening to shallow 'a' wave with respiration, 2) pulmonary 'a' wave seemed to be produced mainly by the motion due to the ventricular filling or pressure change during atrial systole superimposed on the entire cardiac motion, especially during inspiration. The 'a' wave appeared to reflect the diastolic hemodynamics of right heart, 3) the pulmonary valve echogram recorded during expiratory phase should be adopted for the assessment of right cardiac dynamics.
It was preliminarily reported that presystolic opening of the pulmonary valve was observed also in constrictive pericarditis.