Mechanism and incidence of notched pulmonary venous atrial reversal wave.
In certain patients, pulmonary venous flow pattern obtained by the pulsed wave Doppler during transesophageal echocardiography shows a notching on the atrial reversal (A) wave. However, the incidence or the mechanism of this notched A wave has not been described. After transthoracic echocardiographic evaluation for the chamber sizes, wall thickness, and left-ventricular function, transesophageal echocardiography was performed in 100 patients with in sinus rhythm. Discernible pulmonary venous A wave was observed in 46 patients. Among these 46 patients, notched A wave was observed in 11 (31%). In 4 patients with notched A wave, left-atrial pressure waveforms could be obtained during mitral balloon valvuloplasty. In all these patients, left-atrial pressure waveforms showed prominent c waves. In 2 patients, transesophageal echocardiography was repeated after mitral balloon valvuloplasty. Late peak of the notched A wave decreased with the decrease in the magnitude of rise in left-atrial c wave. Among the transthoracic echocardiographic parameters, patients with notching (n = 11) had significantly larger left atriums than patients without notching (n = 35)(49.3 +/- 6.2 vs 37.3 +/- 4.4 mm, P <.0001). There were no significant differences in left-ventricular dimensions, wall thickness, and ejection fraction. In conclusion, notched pulmonary venous A wave indicates the presence of left-atrial c wave; and presence of left-atrial c wave may represent decreased left-atrial compliance.
Sohn
Dae-Won
DW
Division of Cardiology, Department of Internal Medicine, Seoul National University College of Medicine, 28 Yungun-Dong, Chongno-Gu, Seoul 110-744, Korea. dwsohn@snu.ac.kr
Choi
Rak-Kyeong
RK
Kim
Yong-Jin
YJ
D000328:Adult; D002404:Catheterization; D017548:Echocardiography, Transesophageal; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D015994:Incidence; D007723:Korea; D008297:Male; D008875:Middle Aged; D008946:Mitral Valve Stenosis / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D011652:Pulmonary Circulation / Q000502:physiology; D011667:Pulmonary Veins / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D013318:Stroke Volume / Q000502:physiology; D013927:Thrombosis / Q000453:epidemiology* / Q000503:physiopathology* / Q000628:therapy; D016896:Treatment Outcome