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Case Studies: Pseudoreversal of the Atrioventricular Valves E and A Points

John C. Hobbins

Elizabeth M. Shaffer

Pulsed Doppler evaluation of the atrioventricular valves is standard in a fetal echocardiogram. In the normal fetal mitral and tricuspid valve waveforms, the E point, which reflects passive ventricular filling, is always lower in velocity than the A point, which reflects atrial contraction. In the setting of intrauterine growth retardation, the E and A point relationship may be reversed, with the E point displaying a higher velocity than the A point. It should be born in mind, however, that improper Doppler interrogation angle may cause a pseudoreversal of these 2 points. Therefore, meticulous attention should be paid to interrogation angle to avoid the potential of an erroneous diagnosis.

Key Words: fetal echocardiography • pulsed Doppler • Doppler angle

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