Transesophageal color Doppler flow mapping of iatrogenic left-to-right interatrial shunting after percutaneous transluminal mitral valvotomy.
Characteristics of transesophageal color Doppler flow mapping of iatrogenic left-to-right interatrial shunts were assessed in 58 patients, 1 to 994 days after percutaneous transluminal mitral valvotomy.  Transesophageal color Doppler flow mapping detected 22 cases of interatrial shunt whereas transthoracic two-dimensional echocardiography visualized only five interatrial septal defects.  Five types of color Doppler flow patterns of interatrial shunts were found: type 1, a bluish jet passing through the interatrial septum into the right atrium with a small bluish proximal flow in the left atrium (50%); type 2, a bluish jet passing through the interatrial septum into the right atrium without a proximal flow (13.6%); type 3, a predominant bluish proximal flow in the left atrium passing through the interatrial septum with minimal flow entering into the right atrium (18.2%); type 4, an "en face" bluish jet in the right atrium (4.5%); and type 5, a "wall jet" with proximal flow adhering to and entering into the interatrial septum (13.6%).  Oximetry demonstrated increased pulmonary-to-systemic flow ratio (range 1.07 to 3.32) in 11 patients (50%), which was significantly correlated with the maximal jet area derived from color Doppler flow mapping (r = 0.80, P = 0.001). Thus, transesophageal color Doppler flow mapping is useful in detection of left-to-right interatrial shunts after percutaneous transluminal mitral valvotomy, and recognition of the variable types of color flow mapping may further help identify these atypical interatrial shunts.
Chen
C H
CH
Department of Medicine, Veterans General Hospital-Taipei and National Yang Ming Medical College, Taiwan, Republic of China.
Lin
S L
SL
Yin
W H
WH
Liou
J Y
JY
Hsu
T L
TL
Ting
C T
CT
Chang
M S
MS
Chiang
B N
BN
D000328:Adult; D000368:Aged; D002404:Catheterization / Q000379:methods*; D015150:Echocardiography, Doppler / Q000379:methods*; D005069:Evaluation Studies as Topic; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D008946:Mitral Valve Stenosis / Q000628:therapy*