Pulmonary venous flow pattern―its relationship to cardiac dynamics: a pulsed Doppler echocardiographic study

We studied the physiology of pulmonary venous flow in 13 normal subjects and five patients with atrial rhythm disorders and atrioventricular conduction disturbances with pulsed Doppler and two-dimensional echocardiography. The left atrium, mitral valve, and pulmonary venous ostia were visualized thr...

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Bibliographic Details
Published in:Circulation (New York, N.Y.) N.Y.), 1985-06, Vol.71 (6), p.1105-1112
Main Authors: KEREN, G, SHEREZ, J, MEGIDISH, R, LEVITT, B, LANIADO, S
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Atrial Fibrillation - physiopathology
Biological and medical sciences
Cardiac dysrhythmias
Cardiology. Vascular system
Child
Coronary Circulation
Echocardiography
Female
Heart
Heart - physiology
Heart Block - physiopathology
Humans
Male
Medical sciences
Middle Aged
Mitral Valve - physiology
Myocardial Contraction
Pulmonary Circulation
Regional Blood Flow
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Summary:We studied the physiology of pulmonary venous flow in 13 normal subjects and five patients with atrial rhythm disorders and atrioventricular conduction disturbances with pulsed Doppler and two-dimensional echocardiography. The left atrium, mitral valve, and pulmonary venous ostia were visualized through the apical four-chamber view. Mitral and pulmonary venous flows were obtained by placing the Doppler sample volume at the appropriate orifice. Pulmonary venous flow was biphasic: a rapid filling wave was observed during systole when the mitral valve was closed; a second wave was observed in diastole during the rapid ventricular filling phase of mitral flow, but was significantly delayed. In patients without atrial contraction (atrial fibrillation and sinoatrial standstill), the initial rapid filling was greatly diminished and only the second diastolic wave appeared to contribute to left atrial filling. In patients with high-grade atrioventricular block, each atrial contraction was followed by a surge in flow from the pulmonary veins. These results are consistent with data obtained from invasive measurements in both dogs and man, and confirm the validity of the use of pulsed Doppler echocardiography in the study of pulmonary venous flow. We suggest that pulmonary venous flow is influenced by dynamic changes in left atrial pressure created by contraction and relaxation of the atrium and ventricle. The initial peak in pulmonary venous flow occurs with atrial relaxation simultaneously with the reduction of left atrial pressure, and the second peak occurs with left ventricular relaxation and rapid transmitral filling of the ventricle.
ISSN:0009-7322
1524-4539
DOI:10.1161/01.cir.71.6.1105