Reevaluation of the role of atrial systole to cardiac hemodynamics: Evidence for pulmonary venous regurgitation during abnormal atrioventricular sequencing

Naito, Masahito; Dreifus, Leonard S.; David, Daniel; Michelson, Eric L.; Mardelli, T.Joseph; Kmetzo, James J.

doi:10.1016/0002-8703(83)90530-6

Cited by 55 publications

(11 citation statements)

References 39 publications

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“…Unlike previous work ers [5,21], we were able to demonstrate a reverse flow in the pulmonary veins during atrial systole. A similar reverse flow has recently been demonstrated in the pul monary veins by transoesophageal Doppler echocardiog raphy during atrial systole and transmitral 'A' flow peak [22], Atrial systole results in a forward flow across the mitral valve and a retrograde flow into the pulmonary veins [23]. When there is a decrease in the compliance of the left ventricle, there will be a larger increase in the left atrial pressure during atrial systole causing the retrograde flow in the pulmonary veins to become relatively larger than the flow through the mitral valve.…”

Section: Discussionsupporting

confidence: 64%

Magnetic Resonance Measurement of Pulmonary Venous Flow and Distensibility

Mohiaddin¹,

Amaki²,

Longmore³

1992

Am J Noninvas Cardiol

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Magnetic resonance velocity mapping was used to study the pulmonary venous flow pattern and to measure pulmonary venous flow volume in 10 normal subjects. Pulmonary venous flow showed a forward flow with two peaks, one during ventricular systole and another in diastole. A reversed flow during atrial systole was noticed. The flow pattern is understandable in relation to the dynamics of the left heart and is consistent with flow patterns obtained by other techniques. Right and left lower pulmonary venous flow was measured and corrected for body surface area. Flow (means ± SD) in the right lower pulmonary vein was 13.0 ±3.7 ml/s/m^2 and in the left 11.9 + 2.2 ml/s/m^2. Distensibility of the pulmonary veins was studied from changes in the cross-sectional areas of pulmonary veins throughout the cardiac cycle, non-significant changes were demonstrated reflecting the non-distensible nature of these vessels. Magnetic resonance imaging provides a totally noninvasive technique for qualitative and quantitative examination of pulmonary venous flow which could be of clinical value in the assessment of both cardiac and pulmonary problems.

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Section: Discussionsupporting

confidence: 64%

Magnetic Resonance Measurement of Pulmonary Venous Flow and Distensibility

Mohiaddin¹,

Amaki²,

Longmore³

1992

Am J Noninvas Cardiol

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“…Inasmuch as the timing of atrial systole relative to ventricular systole is extremely important for optimal atrial emptying (24), particularly with high left atrial pressures, the absence of atrioventricular synchrony limits left ventricular filling and thus cardiac output. Finally, both mitral regurgitation (25) and pulmonary venous regurgitation (26) have been reported with improper timing of atrial systole relative to ventricular systole, so that a proportion of left ventricular output does not contribute to forward cardiac output. All of these factors contribute to the limited increase in cardiac output in response to volume loading seen in our study.…”

Section: Discussionmentioning

confidence: 99%

Regulation of Cardiac Output with Controlled Heart Rate in Newborn Lambs

et al. 1988

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“…This wave may be extremely important for evaluating LA function in the pulmonary vein-LA-LV hemodynamic relationship during ventricular end-diastole [10][11][12]. In some patients, a reversed wave for the PVF velocity pattern (PVC) is transmitted from the LA to the pulmonary veins, which is consistent with mitral valve closure.…”

Section: Basic Understandingmentioning

confidence: 96%

Renewed Interest in Left Atrial Function: What do we Need to Evaluate Clinically?

et al. 2005

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The use of a Swan-Ganz catheter has resulted in the accurate evaluation of the severity of acute left heart failure, making it possible to establish appropriate therapeutic strategies for this disorder using Forrester s classification. The routine use of clinical echocardiography has facilitated the noninvasive diagnosis of hemodynamic abnormalities related to various disease conditions. In particular, transmitral flow (TMF) and pulmonary venous flow (PVF) velocity patterns, acquired by the pulsed Doppler method, have led to the establishment of a new clinical field, diastology [1].Previously, the left ventricle (LV) was the focus of investigation when evaluating left heart function, and the left atrium (LA) was considered to have a minor supporting role. However, recent studies have focused on the role of the LA, because it has been recognized that a thorough understanding of LA performance is essential to evaluate more accurately left heart diseases [2]. When evaluating LV function clinically, hemodynamic abnormalities in the pulmonary vein-LA-LV relationship should always be considered, and echocardiography may be an indispensable tool for obtaining important information concerning the relationship between the pulmonary veins and LV with the LA playing a central role.In this review, we summarize how to evaluate LA function using echocardiography with the role of LA function in patients with left-side heart failure. Basic UnderstandingLeft atrial function is classified into 3 categories based on hemodynamic characteristics [3-6]: 1) reservoir function for blood returning from the pulmonary veins due to active relaxation and passive expansion of the LA during ventricular systole; 2) conduit function promoting direct blood inflow from the pulmonary veins to the LV during ventricular diastole; and 3) booster pump function that is responsible for active ejection of blood into the LV during atrial systole.The blood inflow from the pulmonary veins to the LA and that from the LA to the LV can be evaluated by pulsed Doppler echocardiography based on the PVF velocity pattern (Figure 1, PVF) and the TMF velocity pattern (Figure 1, TMF). Because LA filling and emptying are involved in the hemodynamic relationship between the pulmonary veins, LA and LV, the LA appendage flow velocity pattern (Figure 1, LAAF), recorded by pulsed Doppler echocardiography, and the mitral annular motion velocity pattern (Figure 1, MAMV), recorded by tissue Doppler imaging, also may be important indices for assessing LA function in addition to the LA size determined by M-mode and 2-and 3-dimensional echocardiography, which assess

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Reevaluation of the role of atrial systole to cardiac hemodynamics: Evidence for pulmonary venous regurgitation during abnormal atrioventricular sequencing

Cited by 55 publications

References 39 publications

Magnetic Resonance Measurement of Pulmonary Venous Flow and Distensibility

Magnetic Resonance Measurement of Pulmonary Venous Flow and Distensibility

Regulation of Cardiac Output with Controlled Heart Rate in Newborn Lambs

Renewed Interest in Left Atrial Function: What do we Need to Evaluate Clinically?

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