Effects of mitral regurgitation on pulmonary venous flow and left atrial pressure: an intraoperative transesophageal echocardiographic study.
OBJECTIVE
Pulmonary venous flows recorded by pulsed wave Doppler transesophageal echocardiography examination can be used to assess the severity of mitral regurgitation. Pulmonary venous flows are also related to left atrial pressures; however, the determinants of these flows have yet to be characterized in the presence of mitral regurgitation.


METHODS
We simultaneously recorded intraoperative pulmonary venous flows by transesophageal echocardiography and left atrial pressures by direct left atrial puncture in 16 patients with different grades of mitral regurgitation: 2+ (n = 5), 3+ (n = 4) and 4+ (n = 7). Pulmonary venous peak systolic and diastolic flow velocities and peak reversed systolic flow velocities were compared with left atrial pressure a and v waves, a-x and v-y descent values and left atrial volumes.


RESULTS
Pulmonary venous systolic to diastolic flow ratios correlated with decreases in left atrial pressure a/v ratios and with increases in the v waves of patients with higher grades of mitral regurgitation. Univariate analysis revealed that the best determinants of the pulmonary venous systolic to diastolic flow ratio were the left atrial pressure v wave (r = -0.76), the v-y descent value (r = -0.73) and the a/v ratio (r = 0.71). Lower correlations were found for left atrial end-systolic (r = -0.48) and end-diastolic (r = -0.42) volumes. Reversed systolic flow was present in patients with 4+ mitral regurgitation, despite left atrial enlargement.


CONCLUSIONS
Pulmonary venous flow can be used to assess the severity of mitral regurgitation and reflects the effects of mitral regurgitation severity on the left atrial pressure a and v waves.
Klein
A L
AL
Department of Cardiology, Cleveland Clinic Foundation, Ohio 44195-5064.
Stewart
W J
WJ
Bartlett
J
J
Cohen
G I
GI
Kahan
F
F
Pearce
G
G
Husbands
K
K
Bailey
A S
AS
Salcedo
E E
EE
Cosgrove
D M
DM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D016279:Atrial Function, Left / Q000502:physiology*; D001794:Blood Pressure / Q000502:physiology*; D006328:Cardiac Catheterization / Q000295:instrumentation / Q000379:methods; D004452:Echocardiography / Q000379:methods* / Q000706:statistics & numerical data; D004947:Esophagus; D005260:Female; D006801:Humans; D007430:Intraoperative Care / Q000379:methods / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology* / Q000601:surgery; D011652:Pulmonary Circulation / Q000502:physiology*; D011667:Pulmonary Veins / Q000000981:diagnostic imaging / Q000503:physiopathology*