Pulmonary venous flow by doppler echocardiography: revisited 12 years later
Tomotsugu Tabata, MD, FACC*,
James D. Thomas, MD, FACC* and
Allan L. Klein, MD, FACC*,*
* Cardiovascular Imaging Center, Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
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Figure 1 Pulmonary venous flow velocity profile in a 60-year-old normal subject. Pulmonary venous systolic wave is usually greater than early diastolic wave. Note the pulmonary venous first systolic wave (S1) and pulmonary venous second systolic wave (S2). AR = pulmonary venous atrial reversal wave; D = pulmonary venous early diastolic wave.
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Figure 2 Pulmonary venous flow (PVF) (top) and mitral inflow (bottom) velocity profiles recorded by transesophageal echocardiography in patients with left ventricular diastolic dysfunction. (A) Relaxation abnormality pattern. The peak pulmonary venous systolic velocity (S) increased. The peak pulmonary venous early diastolic velocity (D) decreased, and its deceleration time increased corresponding to the change in mitral inflow early diastolic wave (E). (B) Pseudonormal pattern. The PVF shows a markedly increased atrial reversal wave (AR) and a normal S to D velocity ratio with normalized mitral inflow velocity pattern. The deceleration time of the D wave is shortened. (C) Restrictive pattern. The PVF shows a markedly decreased S to D velocity ratio with markedly shortened deceleration times of the D and E waves. A = mitral inflow late diastolic wave. Panels B and C from Klein AL, Canale MP, Rajagopalan N, et al. Role of transesophageal echocardiography in assessing diastolic dysfunction in a large clinical practice: a 9-year experience. Am Heart J 1999;138:880–9; reproduced with permission.
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Figure 3 Pulmonary venous flow (PVF) velocity profiles recorded by transesophageal echocardiography with respiratory monitoring. (A) Patient with cardiac amyloidosis shows pseudonormal pattern characterized by slight blunting of pulmonary venous systolic wave (S) throughout the respiratory cycle with a large atrial reversal. (B) Patient with constrictive pericarditis and sinus rhythm shows a marked respiratory variation. Both the pulmonary venous systolic and early diastolic (D) flow velocities decreased from expiration to inspiration. (C) Patient with constrictive pericarditis and atrial fibrillation also shows similar respiratory variation in the PVF. Both the S and D velocities increased at the onset of expiration, even with a short RR interval, and decreased at the onset of inspiration with a long RR interval. Exp = expiration; Insp = inspiration.
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Figure 4 (A) Simultaneous recording of the pulmonary venous flow (PVF) using transesophageal echocardiography and left atrial pressure (LAP) in patients with 4+ mitral regurgitation (MR). The pulmonary venous systolic wave (S) was blunted, and late systolic reversal flow (SRF) was observed corresponding to the large LAP "v" wave. (B) Relationship between LAP and PVF in 2+, 3+, and 4+ MR. As MR grade increases, the "v" wave and "v-y" descent increase, and the "a" wave and "a-x" descent decrease, which is consistent with decrease in S wave, increase in D and SRF waves. ECG = electrocardiogram. From Klein AL, Savage RM, Kahan F, et al. Experimental and numerically modeled effects of altered loading conditions on pulmonary venous flow and left atrial pressure in patients with mitral regurgitation. J Am Soc Echocardiogr 1997;10:41–51; reproduced with permission.
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Figure 5 Pulmonary vein stenosis induced by radiofrequency ablation for atrial fibrillation. Left upper pulmonary vein stenosis (arrow) is seen by two-dimensional echocardiography (left), and the peak velocities of pulmonary venous systolic (S) and early diastolic (D) waves are markedly increased (right). Ao = ascending aorta; AR = pulmonary venous atrial reversal wave; LA = left atrium; LPV = left upper pulmonary vein.
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