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.
Department of Medicine, Veterans General Hospital-Taipei and National Yang Ming Medical College, Taiwan, Republic of China.
C H
CH
Chen
S L
SL
Lin
W H
WH
Yin
J Y
JY
Liou
T L
TL
Hsu
C T
CT
Ting
M S
MS
Chang
B N
BN
Chiang
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*