Determinants of forward pulmonary vein flow
An open pericardium pig model
Paolo Barbier, MDa,1,
Steve Solomon, PhDa,2,
Nelson B. Schiller, MD, FACCa and
Stanton A. Glantz, PhD, FACCa
a Cardiovascular Research Institute and Department of Medicine, University of California, San Francisco, San Francisco, California, USA
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Figure 1 Epicardial cross-sectional longitudinal examination of the left atrial (LA) cavity, a pulmonary vein sinus (s) and a left lower pulmonary vein (v) (from pig # 566). (A) The LA high-fidelity catheter (white arrow) is advanced in and indicates a lower left pulmonary vein. (B) Color Doppler inflow into the LA chamber from the pulmonary vein. The white asterisk indicates the pulmonary vein.
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Figure 2 Example of synchronous left atrial (LA) and pulmonary vein (PV) tracings with the respective a and v peak pressures and x and y nadir pressure points. (B) PV pressure pullback tracing. Top panel, from left to right: the Millar pressure catheter is slowly withdrawn from a retrograde wedge position deep within a left lower PV to the PV sinus in the LA cavity. Lower left and right panels: magnification of LV and PV pressure tracings, respectively, near the Millar catheter wedge position and proximal to the PV sinus. The thin line represents the LV pressure, and the thick line the PV pressure tracing. a = left atrial peak a wave pressure; ECG = electrocardiogram; LAP = left atrial pressure; LVP = LV pressure; PVP = PV pressure; v = left atrial peak v wave pressure; x = left atrial x pressure nadir; y = left atrial y pressure nadir.
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Figure 3 (A) Example of pulsed Doppler PV flow velocity tracing from pig # 565 (baseline paced at 70 beats/min). White arrow indicates 20 cm/s pulsed Doppler velocity scale. Thick white arrow points at missing end-diastolic reverse wave. Black arrow indicates point of flow velocity nadir between the late systolic and early diastolic waves. (B) Example of pulsed Doppler left ventricular outflow tract (LVOT) velocity tracing from pig # 564 (baseline paced at 70 beats/min). a = start of LVOT velocity; b = peak LVOT velocity; c = end of LVOT velocity; D = early diastolic wave; ES = early systolic wave; LAP = left atrial pressure tracing; LS = late systolic wave; Ppace = right atrial pacing artifact; R = ECG R wave.
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Figure 4 From top to bottom, synchronized ECG, left atrial (LA) ABD (thin grey line), pressure (thick white line), pulsed Doppler pulmonary vein flow (PVF) and pulsed Doppler LV outflow tract (LVOT) velocity tracings (from pig # 566, baseline paced at 70 beats/min). The PVF late diastolic retrograde wave has been omitted for clarity. White vertical arrows indicate 20 cm/s pulsed Doppler velocity scale. White dotted lines indicate start and end of left ventricular ejection. a = LA peak a pressure; Amax = maximum LA area; Aac = LA area before atrial contraction; D = diastolic PVF wave; ES = early systolic PVF wave; LS = late systolic PVF wave; P = ECG P wave; R = ECG R wave; v = LA peak v pressure; x = LA x trough pressure.
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Figure 5 (A) Examples of pulsed Doppler recordings of pulmonary vein flow (PVF) from pigs # 564, 566 and 569 at baseline paced at 70 beats/min (left panels) and ischemia paced at 70 beats/min (right panels). (B) Examples of left atrial (LA) pressure tracings (thick lines) from the same pigs, at baseline paced at 70 beats/min (left panels) and ischemia paced at 70 beats/min (right panels). White vertical arrows indicate 20 cm/s pulsed Doppler velocity scale. Note overall positive relation between LA peak a to x trough pressure difference and PVF early systolic peak velocity and inverse relation between height of LA pressure peak v wave or x trough and peak PVF late systolic wave velocity-time integral or peak velocity. The PVF late diastolic retrograde wave has been omitted. a = LA peak a pressure; c = LA peak c pressure; D = diastolic PVF wave; ECG = electrocardiographic tracing; ES = early systolic PVF wave; LS = late systolic PVF wave; Ppace = right atrial pacing artifact; R = EKG R wave; v = LA peak v pressure.
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