Background: Doppler echocardiographic parameters of the middle hepatic vein (MHV)in detecting PHTN. Methods: The study comprised 72 patients who were referred for right heart catheterization (RHC) to our department . All patients underwent conventional transthoracic echocardiography (TTE) the day after RHC and Doppler study of the MHV. Based on RHC and TTE results, Patients were divided in three groups 1: patients with PHTN without significant RV dysfunction (n=25), 2: patients with PHTN with significant RV dysfunction (n=22), 3: patients with normal PAP (n=25). Results: The analysis revealed a significant relationship between A velocity and PHTN among patients with significant RV dysfunction (p=0.033) and PHTN without significant RV dysfunction (p=0.020). At cut-off value of 39.5 cm/s, A velocity could detect PHTN in patient with significant RV dysfunction with sensitivity and specificity of 77.3% and 56.0%, respectively. At cut-off value of 38.5 cm/s, A velocity could detect PHTN without significant RV dysfunction with sensitivity and specificity of 76.0% and 51.0%, respectively. The ROC curve analysis was performed to assess the sensitivity of the hepatic venous systolic filling fraction in detecting normal SPAP in the study population. The area under curve was 0.718. Considering the cut-off value of 0.535 for the hepatic venous systolic filling fraction, the sensitivity and specificity of S/S+D for detecting normal SPAP were 80% and 64%, respectively . Discussion: Doppler echocardiographic parameters of the MHV could be helpful in detecting PHTN. A/S higher than 1 in PHTN was the main finding on HV Doppler assessment in PHT with and without significant RV dysfunction. HV systolic filling fraction more than 0.535 was a sensitive parameter in detecting normal PAP, therefore; HV systolic filling fraction can be used as a screening echocardiographic parameter in ruling out PHTN.

Introduction. Use of implantable endocardial electronic devices is widely increasing due to pro-longed life span of the community. Several studies evaluated the effect of right ventricular (RV) leads on tricuspid valve by three-dimensional transthoracic echocardiography (3D-TTE); howev-er, this affect has not yet been assessed by post-procedural fluoroscopy. Hence, the purpose of the current study was to evaluate the effect of RV lead placement on tricuspid valve, utilizing fluoroscopy in combination with 3D-TEE. Methods. We prospectively enrolled 59 patients who underwent clinically indicated pacemaker or implantable cardioverter defibrillator (ICD) implantation. Vena contracta (VC) and tricuspid regurgitation (TR) severity were measured using two-dimensional transthoracic echocardiography (2D-TTE) at baseline. Follow up 3D-TTE was performed six months after device implantation to assess TR severity and RV lead location. Results. TR VC was increased after the lead placement, compared to the baseline study (VC: 3.86 ± 2.32 vs 3.18 ± 2.39; p = 0.005). The mean changes in VC levels were 1.14 ± 0.67 mm (Range: -0.4-2.5 mm) after inserting the lead. Among all investigated parameters, VC changes were predicted based on lead placement position only in 3D-TTE (p<0.001) while the other var-iables including fluoroscopy parameters were not predictive. Conclusion. The RV Lead location examined by 3D-TTE seems to be a valuable parameter to predict the changes in the severity of the tricuspid regurgitation. Fluoroscopy findings did not improve the predictive performance ,at least in short term follow up.