The pulmonary venous systolic flow pulse—its origin and relationship to left atrial pressure

Smiseth, Otto A.; Thompson, Christopher R.; Lohavanichbutr, Kamol; He, Ling; Abel, James G.; Miyagishima, Robert T.; Lichtenstein, S.; Bowering, John

doi:10.1016/s0735-1097(99)00300-9

Cited by 123 publications

(83 citation statements)

References 22 publications

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“…Other factors involved have been evaluated, such as left atrium relaxation and compliance and left ventricular function. [21][22][23][24][25][26][27] Pulmonary vein relaxation, mediated by C-type natriuretic peptide, is uniform and thus does not allow segmental variations. 28 The effects of vessel tapering in the pulmonary circulation have been studied by nonlinear models, 6,10 and the role of the vessel cross-sectional area in the flow wave dynamics has also been assessed.…”

Section: Discussionmentioning

confidence: 99%

Dynamics of the Pulmonary Venous Flow in the Fetus and Its Association With Vascular Diameter

Zielinsky¹,

Piccoli²,

Gus³

et al. 2003

Circulation

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Background-The usual positioning of the Doppler sample volume to assess fetal pulmonary vein flow is in the distal portion of the vein, where the vessel diameter is maximal. This study was performed to test the association of the pulmonary vein pulsatility index (PVPI) with the vessel diameter. Methods and Results-Twenty-three normal fetuses (mean gestational age, 28.6Ϯ5.3 weeks) were studied by Doppler echocardiography. Pulmonary right upper vein flow was assessed adjacent to the venoatrial junction ("distal" position) and in the middle of the vein ("proximal" position). The vessel diameter was measured by 2D echocardiography with power Doppler, and the PVPI was obtained by the ratio (maximal velocity [systolic or diastolic peak]Ϫminimal velocity [presystolic peak])/mean velocity. The statistical analysis used t test and exponential correlation studies. Mean distal diameter was 0.33Ϯ0.10 cm (0.11 to 0.57 cm), and mean proximal diameter was 0.16Ϯ0.08 cm (0.11 to 0.25 cm) (PϽ0.0001). Mean distal PVPI was 0.84Ϯ0.21 (0.59 to 1.38), and mean proximal PVPI was 2.09Ϯ0.59 (1.23 to 3.11) (PϽ0.0001). Exponential inverse correlation between pulmonary vein diameter and pulsatility index was highly significant (PϽ0.0001), with a determination coefficient of 0.439. Conclusions-In the normal fetus, the pulmonary venous flow pulsatility decreases from the lung to the heart, and this parameter is inversely correlated to the diameter of the pulmonary vein, which increases from its proximal to its distal portion. This study emphasizes the importance of the correct positioning of the Doppler sample volume, adjacent to the venoatrial junction, to assess pulmonary venous flow dynamics.

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Section: Discussionmentioning

confidence: 99%

Dynamics of the Pulmonary Venous Flow in the Fetus and Its Association With Vascular Diameter

Zielinsky¹,

Piccoli²,

Gus³

et al. 2003

Circulation

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“…Systolic forward flow is often biphasic with S1 related to atrial relaxation and LA pressure while S2 is related to stroke volume and propagation in the arterial tree 44 , 45 (S2 is used to derive S/D ratio). D velocity is influenced by LV filling and compliance and changes parallel to mitral E velocity 46 .…”

Section: Pulmonary Venous Flow Patternsmentioning

confidence: 99%

Echocardiographic evaluation of diastolic heart failure

Thomas

2010

Australas J Ultrason Med

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“…Forward-going compression waves increase pressure and increase velocity, whereas backward-going compression waves increase pressure and decrease velocity (in the forward direction). Expansion waves have a "pulling" effect and decrease pressure (43). Forward-going expansion waves decrease pressure and decrease velocity, whereas backward-going expansion waves decrease pressure and increase velocity (in the forward direction).…”

mentioning

confidence: 99%

Assessment of left ventricular diastolic suction in dogs using wave-intensity analysis

Wang¹,

Jalali²,

Sun³

et al. 2005

American Journal of Physiology-Heart and Circulatory Physiology

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. Assessment of left ventricular diastolic suction in dogs using wave-intensity analysis. Am J Physiol Heart Circ Physiol 288: H1641-H1651, 2005. First published November 24, 2004 doi:10.1152/ajpheart.00181.2004.-Two apparently different types of mechanisms have emerged to explain diastolic suction (DS), that property of the left ventricle (LV) that tends to cause it to refill itself during early diastole independent of any force from the left atrium (LA). By means of the first mechanism, DS depends on decreased elastance [e.g., the relaxation time constant ()] and, by the second, end-systolic volume (VLVES). We used waveintensity analysis (WIA) to measure the total energy transported by the backward expansion wave (IWϪ) during LV relaxation in an attempt to reconcile these mechanisms. In six anesthetized, open-chest dogs, we measured aortic, LV (PLV), LA (PLA), and pericardial pressures and LV volume by orthogonal ultrasonic crystals. Mitral velocity was measured by Doppler echocardiography, and aortic velocity was measured by an ultrasonic flow probe. Heart rate was controlled by pacing, VLVES by volume loading, and by isoproterenol or esmolol administration. IWϪ was found to be inversely related to and VLVES. Our measure of DS, the energy remaining after mitral valve opening, IWϪDS, was also found to be inversely related to and VLVES and was ϳ10% of the total "aspirating" energy generated by LV relaxation (i.e., I WϪ). The size of the Doppler (early filling) E wave depended on IWϪDS in addition to IWϩ, the energy associated with LA decompression. We conclude that the energy of the backward-going wave generated by the LV during relaxation depends on both the rate at which elastance decreases (i.e., ) and V LVES. WIA provides a new approach for assessing DS and reconciles those two previously proposed mechanisms. The E wave depends on DS in addition to LA decompression. diastole; hemodynamics; mitral valve; ventricles DIASTOLIC SUCTION (DS) is defined as that property of the left ventricle (LV) that tends to cause it to refill itself during early diastole independent of any force from the left atrium (LA). Two apparently different types of mechanistic explanations have emerged. The first type is represented by Katz (30) and Wiggers (52), who related DS to the decrease in ventricular elastance, and by several contemporary investigators (11,12,38,47) who emphasized the importance of the rate of LV relaxation in subsequent diastolic filling. In 1957, Wiggers wrote that "During early moments of ventricular relaxation, elastic stresses created during contraction are released. . . If blood could enter the ventricular chamber during this phase of diastole, such a rapid drop in pressure would unquestionably constitute a potent aspirating force" (52).Wiggers implied that the relaxing LV generates an "aspirating force" from the moment LV pressure begins to decrease. Accordingly, as elaborated upon below, the first effect of a relaxation-generated aspirating force must be to decelerate the mass represented by the stroke v...

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The pulmonary venous systolic flow pulse—its origin and relationship to left atrial pressure

Cited by 123 publications

References 22 publications

Dynamics of the Pulmonary Venous Flow in the Fetus and Its Association With Vascular Diameter

Dynamics of the Pulmonary Venous Flow in the Fetus and Its Association With Vascular Diameter

Echocardiographic evaluation of diastolic heart failure

Assessment of left ventricular diastolic suction in dogs using wave-intensity analysis

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