1276 Brief Communications June, 1994 American Heart Journal Fig. 1. Doppler aortic flow velocity recorded with continuous-wave Doppler transducer placed along the right parasternal border. Note the spectral display showingintense blackening of the peaks. parasternal border. Hence, the DAV measurementsin elderly subjects should always be attempted from the SSN and/or the RPB. As the 2DE image obtained from these windows in elderly subjects is of poor quality, it is often difficult to use the pulsed Doppler technique. We found that the small dual-crystal continuous-wave echo Doppler transducer (Pedof Irex System III) used along with a spectral analyzer is ideal for measuring DAV from SSN and RPB. Since the measurements of Doppler aortic velocity in this study are not compared with alternate measures of flow velocity, the data by the noninvasive technique may be questioned.Reproducibility of the data by two independent observers was excellent and the velocity measurements were clearly within the physiologic range. This leads us to conclude that the data obtained accurately reflect the normal values in this agegroup. The data presented in the normal subjects may be used to diagnose abnormal velocities resulting from left ventricu- lar outflow obstruction. Furthermore, our experience indi- catesthat a right parasternal or a suprasternalapproach is likely to be more useful than the apical approach in determination of severity of calcific valvular aortic steno- sis seen in the aged, and these approaches using the smaller continuous-waveecho transducers are superior to the pulsed Doppler method. REFERENCES 1. Hatle L, Angelsen BA, Transdal A: Non-invasive assessment of aortic stenosis by Doppler ultrasound. Br Heart J 43:284, 1980. 2. Baler DW, Rubenstein SA, Larch GS: Pulsed Doppler echo- cardiography: Principles and applications. Am J Med 63:69, 1977. 3. Larch G, Rubenstein S, Baker D, Dooley T, Dodge H: Doppler echocardiography. Use of a graphical display system. Circulation 56~576, 1977. 4. Hatle L, Angelsen B: Doppler ultrasound in cardiology. Philadelphia, 1982, Lea & Febiger, Publishers, p 92. 5. Hatle L: Non-invasive assessment and differentiation of left ventricular outflow obstruction with Doppler ultrasound. Circulation 64:381, 1981. Rupture of dissecting sort/c aneurysm into the right atrium: Clinical and echocardiographic recognition Pascal Nicod, M.D., Brian G. Firth, M.D., D. Phil., Ronald M. Peshock, M.D., F. Andrew Gaffney, M.D., and L. David Hillis, M.D. Dallas, Texas Although a dissectingaortic aneurysm may be associated with several complications,’ none is more serious than rupture. Rupture most often occurs into the pericardium From the Department of Internal Medicine (Cardiovascular Division), University of Texas Health Science Center. Reprint requests: L. David HiIlis, M.D., Room L5 134, University of Texas Health Science Center, 5323 Harry Hines Blvd., Dallas, TX 75235.