Transesophageal Pulsed Doppler Echocardiographic Study of Pulmonary Venous Flow in Mitral Stenosis

Tabata, Tomotsugu; Oki, Takashi; Fukuda, Nobuo; Iuchi, Arata; Kawano, T; Manabe, Kazuyo; Tanimoto, Masato; Kageji, Yoshimi; Sasaki, Miwa; Hama, Minori; Ito, Susumu

doi:10.1159/000177072

Cited by 11 publications

(14 citation statements)

References 13 publications

(16 reference statements)

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“…LV systolic pump function is maintained in patients with isolated mitral stenosis. However, there is a slight decrease in PVS 2 that is related to LA enlargement or decreases in compliance [32] (Figure 8, left). In patients with mitral regurgitation, blood flow into the LA cavity during ventricular systole includes inflow from the pulmonary veins and regurgitant flow from the LV.…”

Section: Figmentioning

confidence: 99%

“…Consequently, PVD shows a sharp peak in the rapid ventricular filling phase with a gradually descending slope during mid-diastole [32] (Figure 8, left). One study has reported that the deceleration time for PVD is useful for evaluating PCWP in patients with acute myocardial infarction because the deceleration time of the early diastolic wave for the TMF velocity is closely related to LV diastolic compliance, and the deceleration time of PVD is closely related to LA compliance [42].…”

Section: La Conduit Functionmentioning

confidence: 99%

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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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Section: Figmentioning

confidence: 99%

Section: La Conduit Functionmentioning

confidence: 99%

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

et al. 2005

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“…Forward systolic pumonary venous flow consists of two waves. The second wave was used because the first was not recorded in every patient, particularly in those with atrial fibrillation where an early systolic reversed wave coinciding with mitral closure was generally recorded [3]. Pulmonary venous systolic flow was considered as normal if the systolic/diastolic flow ratio was 61 while a blunted pattern was defined as systolic/diastolic flow ratio !…”

Section: Pulmonary Venous Flow Measurementsmentioning

confidence: 99%

“…Earlier reports have analyzed the pulmonary venous flow pattern in mitral stenosis with widely varying valve areas [2,3]. In this study, we investigated the influence of severe mitral valve stenosis on the pulmonary venous flow pattern as assessed by transesophageal Doppler echocardiography in patients both in sinus rhythm and atrial fibrillation.…”

Section: Introductionmentioning

confidence: 99%

Transesophageal Doppler Echocardiographic Pattern of Pulmonary Venous Flow in Severe Mitral Stenosis

1999

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Objectives: Analysis of the pulmonary venous flow enables an evaluation of cardiac hemodynamics. This study was conducted to evaluate the effect of severe mitral stenosis on the pulmonary venous flow both in sinus rhythm and atrial fibrillation. Methods: We studied 38 patients with isolated severe mitral stenosis (mitral valve area index ≤0.75 cm²) by pulsed wave Doppler transesophageal echocardiography of the left upper pulmonary vein. Twenty-six patients (68%) were in sinus rhythm and 12 (32%) in atrial fibrillation. Results: The peak systolic flow velocity was significantly lower in atrial fibrillation patients with blunted systolic flow pattern in 67%, while the normal flow pattern with higher systolic-to-diastolic flow ratio was found in 69% of sinus rhythm patients. Pulmonary venous flow was significantly delayed in its onset and termination with atrial fibrillation compared to sinus rhythm even after correction for heart rate (p < 0.02, p < 0.04, respectively). The pulmonary venous peak systolic flow velocity showed a significant negative correlation with the mean pulmonary pressure (r = –0.424, p = 0.011). Finally, there was a correlation between the pulmonary venous diastolic pressure half-time and the peak mitral gradient (r = –0.327, p = 0.045), mean mitral gradient (r = –0.369, p = 0.022) and Doppler mitral valve area (r = –0.422, p = 0.008). Conclusion: Severe mitral stenosis is associated with a decreased pulmonary venous systolic flow and prolonged decay of the diastolic flow, and these changes are more marked in atrial fibrillation. These results can help to understand the hemodynamics of mitral stenosis and its interaction with the pulmonary circulation.

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“…Recently, pulsed Doppler echocardiographic assessment of PVF has become a widely accepted method with transesophageal probe to help evaluating left ventricular diastolic function in various cardiac diseases in human medicine [9,14,18,20]. However, transesophageal echocardiography can not be performed in dogs without anesthesia limiting its clinical utility.…”

Section: The Available Imaging Planes and The Anatomic Validation In mentioning

confidence: 99%

Pulmonary Venous Flow in Normal Dogs Recorded by Transthoracic Echocardiography: Techniques, Anatomic Validations and Flow Characteristics.

Chiang

Hagio

Yoshida

et al. 1998

The Journal of Veterinary Medical Science

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ABSTRACT. To observe pulmonary venous flow in dogs, the echocardiographic imaging planes and the techniques for examination, and the validations of anatomic location were investigated. Then, the velocity pattern of pulmonary venous flow was recorded in normal conscious dogs. Six imaging planes were available for observing the right or left caudal lobe pulmonary venous flow with twodimensional or pulsed Doppler echocardiography. Of these, the left lateral apical 4-chamber view can be applied as standard view, because the pulmonary venous flow and transmitral flow could be recorded in this view simultaneously with small sampling angle. The velocity pattern of pulmonary venous flow demonstrated two forward waves in 19 of 20 dogs examined, with one peak occurring during ventricular systole and another during ventricular diastole. A reversed flow during atrial contraction was also seen in 11 dogs. In the two forward waves, the mean peak velocity and velocity-time integral of ventricular diastolic forward flow were significantly higher than those of systolic forward flow (46.49 ± 6.79 vs. 31.13 ± 4.92 cm/s, p<0.0001 and 8.18 ± 1.84 vs. 5.14 ± 0.82 cm, p<0.0001, respectively). The deceleration time of diastolic forward flow shortened with the increase of heart rate (r= 0.87, p<0.0001). Pulmonary venous flow in dogs can be observed under transthoracic two-dimensional or pulsed Doppler echocardiography. -KEY WORDS: canine, pulmonary venous flow, pulsed Doppler, transthoracic echocardiography.J. Vet. Med. Sci. 60(3): 333-339, 1998 available imaging planes and the techniques for examination, and to confirm the anatomic location of pulmonary veins on the imaging plane, finally, to record the characters of the pulsed Doppler pattern of PVF in normal dogs. MATERIALS AND METHODS The available imaging planes and the anatomic validation in two-dimensional echocardiography:Five mongrel dogs weighing 8 to 11 kg (mean weight 9.30 ± 1.52 kg, 3 males and 2 females) obtained from an animal shelter were determined as healthy based on the results of routine physical examination and hematology. No evidence of cardiac or pulmonary abnormality was seen under either auscultation or two-dimensional echocardiography. These dogs were examined in the right or left lateral recumbency under consciousness with two-dimensional and color Doppler echocardiography by an ultrasound instrument (EUB-565A; HITACHI Medical Corporation) and a 5 MHz sector scanning probe (EUP-S32; HITACHI Medical Corporation). The presumed imaging planes for observing the simulacrums of the pulmonary vein were obtained. Then, all five dogs were prepared for lateral thoracotomy.The anesthetic protocol included premedication with atropine (0.02 mg/kg intramuscular) and droperidol (0.5 mg/ kg intravenous), induction with pentobarbital sodium (20 mg/kg intravenous), and maintenance with Halothane (1%-1.5%). Thoracotomy was performed in two dogs from left lateral and in three dogs from right lateral at the fifth or sixth intercostal space after routine aseptic preparations. Fr...

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Transesophageal Pulsed Doppler Echocardiographic Study of Pulmonary Venous Flow in Mitral Stenosis

Cited by 11 publications

References 13 publications

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

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

Transesophageal Doppler Echocardiographic Pattern of Pulmonary Venous Flow in Severe Mitral Stenosis

Pulmonary Venous Flow in Normal Dogs Recorded by Transthoracic Echocardiography: Techniques, Anatomic Validations and Flow Characteristics.

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