Pulmonary venous flows reflect changes in left atrial hemodynamics during mitral balloon valvotomy.
Patients with mitral stenosis have usually blunted pulmonary venous (PV) flow, because of decreased mitral valve area and diastolic dysfunction. The authors compared changes in Doppler PV velocities by using transesophageal echocardiography (TEE) against hemodynamics parameters before and after mitral balloon valvotomy to observe relevance of PV velocities and endsystolic left atrial (LA) pressure-volume relationship. In 25 patients (aged 35 +/- 17 years) with mitral stenosis in sinus rhythm, changes in LA pressure and volumes were compared with PV velocities before and after valvotomy. Mitral valve area, mitral gradients, and deceleration time were obtained. Mitral valve area and mitral gradients changed from 1 +/- 0.2 cm2 and 14.6 +/- 5.4 mmHg to 1.9 +/- 0.3 cm2 and 6.3 +/- 1.7 mmHg, respectively (p<0.001). AR peak reverse flow velocity and AR duration decreased from 29 +/- 13 cm/s and 110 =/- 30 msec to 19 +/- 6 cm/s and 80 +/- 29 msec respectively (p<0.001). Transmitral Doppler E wave deceleration time decreased from 327 +/- 85 to 209 +/- 61 s and cardiac output increased from 4.2 +/- 1.0 to 5.2 +/- 1.1 L/minute (p<0.001). The changes in LA pressure were correlated with changes in S/D (r=0.57, p<0.05). The changes in endsystolic LA pressure-volume relationship were also correlated with changes in S/D (r=0.52, p<0.05). Endsystolic LA pressure-volume relationship decreased after mitral balloon valvotomy, as a result of a large decrease in pressure. PV systolic/diastolic (S/D) waves ratio reflects endsystolic LA pressure-volume relationship and may be used as another indicator of successful valvotomy.
Yalçin
Fatih
F
Department of Cardiology, Başkent University, School of Medicine, Practice and Research Hospital, Adana, Turkey. fatih_yalcin83@hotmail.com
El-Amrousy
Mahmoud
M
Müderrisoğlu
Haldun
H
Korkmaz
Mehmet
M
Flachskampf
Frank
F
Tuzcu
Murat
M
Garcia
Mario G
MG
Thomas
James D
JD
D000328:Adult; D016275:Atrial Function; D001783:Blood Flow Velocity / Q000502:physiology; D006328:Cardiac Catheterization; D002302:Cardiac Output; D002404:Catheterization; D015150:Echocardiography, Doppler / Q000379:methods*; D017548:Echocardiography, Transesophageal; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000000981:diagnostic imaging*; D008946:Mitral Valve Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D011667:Pulmonary Veins / Q000000981:diagnostic imaging / Q000503:physiopathology*