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STATE-OF-THE-ART PAPER

Pulmonary venous flow by doppler echocardiography: revisited 12 years later

^* Cardiovascular Imaging Center, Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, Cleveland, Ohio, USA

Manuscript received December 18, 2001; revised manuscript received November 12, 2002, accepted November 27, 2002.

^* Reprint requests and correspondence: Dr. Allan L. Klein, Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Desk F-15, Cleveland, Ohio 44195, USA.
kleina{at}ccf.org

In 2003, pulmonary venous flow (PVF) evaluation by Doppler echocardiography is being used daily in clinical practice. Twelve years ago, we reviewed the potential uses of PVF in various conditions. Some of its important uses in cardiology have materialized, while others have not and have been supplanted by newer approaches. Current applications of measuring PVF have included: differentiating constrictive pericarditis from restriction, estimation of left ventricular (LV) filling pressures, evaluation of LV diastolic dysfunction and left atrial (LA) function, and grading the severity of mitral regurgitation (MR). However, there have been a number of controversies raised in the use of PVF profiles. Using transthoracic echocardiography, there may be technical issues in measuring the atrial reversal flow velocity. The use of PVF in the evaluation of the severity of MR is not always specific and can be affected by atrial fibrillation (AF) and elevated mean LA pressure. Mitral valvuloplasty and radiofrequency ablation for AF, which are the newer applications of PVF in monitoring invasive procedures, are mentioned. This article reviews the important clinical role of Doppler evaluation of PVF, discusses its limitations and pitfalls, and highlights its newer applications.

Abbreviations and Acronyms   AF   atrial fibrillation   AR   pulmonary venous atrial reversal wave   AV   atrioventricular   D   pulmonary venous early diastolic wave   LA   left atrial/atrium   LV   left ventricle/ventricular   MR   mitral regurgitation   PVF   pulmonary venous flow   S1   pulmonary venous first systolic wave   S2   pulmonary venous second systolic wave   TEE   transesophageal echocardiography   TTE   transthoracic echocardiography

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