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CLINICAL STUDIES

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

^a St. Paul’s Hospital, Vancouver, British Columbia, Canada
^* Rikshospitalet, Oslo, Norway

Manuscript received September 24, 1998; revised manuscript received April 14, 1999, accepted June 3, 1999.

Reprint requests and correspondence: Dr. Otto A. Smiseth, Institute for Surgical Research, Rikshospitalet, 0027 Oslo, Norway
o.a.smiseth{at}rh.uio.no

OBJECTIVES

The purpose of this study was to determine the origin of the pulmonary venous systolic flow pulse using wave-intensity analysis to separate forward- and backward-going waves.

BACKGROUND

The mechanism of the pulmonary venous systolic flow pulse is unclear and could be a "suction effect" due to a fall in atrial pressure (backward-going wave) or a "pushing effect" due to forward-propagation of right ventricular (RV) pressure (forward-going wave).

METHODS

In eight patients during coronary surgery, pulmonary venous flow (flow probe), velocity (microsensor) and pressure (micromanometer) were recorded. We calculated wave intensity (dP x dU) as change in pulmonary venous pressure (dP) times change in velocity (dU) at 5 ms intervals. When dP x dU > 0 there is a net forward-going wave and when dP x dU < 0 there is a net backward-going wave.

RESULTS

Systolic pulmonary venous flow was biphasic. When flow accelerated in early systole (S1), pulmonary venous pressure was falling, and, therefore, dP x dU was negative, –0.6 ± 0.2 (x ± SE) W/m², indicating a net backward-going wave. When flow accelerated in late systole (S2), pressure was rising, and, therefore, dP x dU was positive, 0.3 ± 0.1 W/m², indicating a net forward-going wave.

CONCLUSIONS

Pulmonary venous flow acceleration in S1 was attributed to a net backward-going wave secondary to a fall in atrial pressure. However, flow acceleration in S2 was attributed to a net forward-going wave, consistent with propagation of the RV systolic pressure pulse across the lungs. Pulmonary vein systolic flow pattern, therefore, appears to be determined by right- as well as left-sided cardiac events.

Abbreviations and Acronyms   AS = atrial systole   AV = atrioventricular   A-wave = pressure wave generated by the atrial systole   CABG = coronary artery bypass grafting   CAD = coronary artery disease   D = diastole   dP x dU = product of increments in pressure (dP) and velocity (dU) over 5 ms intervals   ECG = electrocardiogram   LA = left atrial or atrium   LV = left ventricular or ventricle   Peak D flow rate = peak pulmonary venous diastolic flow rate   Peak S flow rate = peak pulmonary venous systolic flow rate   PV = pulmonary vein or venous   RV = right ventricular or ventricle   S = systole   S1 = early systolic flow pulse   S2 = late systolic flow pulse   VS = ventricular systole

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