title: Role of transthoracic Doppler pulmonary venous flow pattern in large atrial septal defects.
abstract: OBJECTIVE
  Large uncomplicated atrial septal defect (ASD) alters the pulmonary venous flow (PVF) pattern. We aimed to study the role of transthoracic echocardiography (TTE) in estimating the PVF Doppler abnormalities in ASD. By repeating the study soon after ASD closure, we correlated the hemodynamics of atrial shunting with PVF patterns.
  
  
  METHODS
  This study was performed in a tertiary care referral teaching hospital in 2003. The TTE PVF patterns of 34 patients with ASD were studied. TTE study was reported by two blinded investigators independently. Surgical closure of ASD was done on eleven patients and the early postoperative PVF Doppler pattern was also studied with TTE.
  
  
  RESULTS
  PVF patterns were adequately recorded in 34 of 38 (90%) subjects with ASD with equal male: female ratio (n = 17 each). The mean age of the study group was 21.4 +/- 8.7 years. ASD ranged from 10 to 38 mm in diameter with a mean of 18 +/- 4.2 mm. Continuous antegrade wave (CAW, mean 68.45 +/- 13.6 cm/s) replaced normally occurring S and D waves in all ASD patients. The atrial reversal wave was reduced or absent (mean 20.18 +/- 3.28 cm/sec). After ASD closure, the CAW was replaced by the S (46.18 +/- 7.5 cm/sec) and D waves (57.72 +/- 9.7 cm/sec) with increase in atrial reversal wave to 27.81 +/- 5.1 cm/sec.
  
  
  CONCLUSIONS
  The S and D antegrade waves normally seen in PVF are replaced by a continuous antegrade wave in ASD. Atrial reversal wave is also reduced. PVF waveform becomes normal after ASD closure. TTE PVF Doppler pattern can help estimate ASD hemodynamics.
authors.affiliation: Department of Cardiology, Madras Medical College & Research Institute, Chennai, India 600 003. drcanands@yahoo.co.in
authors.forename: Anand
authors.initials: A
authors.lastname: Chockalingam
authors.forename: SriHari
authors.initials: S
authors.lastname: Dass
authors.forename: R
authors.initials: R
authors.lastname: Alagesan
authors.forename: D
authors.initials: D
authors.lastname: Muthukumar
authors.forename: M A
authors.initials: MA
authors.lastname: Rajasekar
authors.forename: T
authors.initials: T
authors.lastname: Subramaniam
authors.forename: V
authors.initials: V
authors.lastname: Jaganathan
authors.forename: S
authors.initials: S
authors.lastname: Elangovan
mesh_terms: D000293:Adolescent; D000328:Adult; D001783:Blood Flow Velocity / Q000502:physiology; D018618:Echocardiography, Doppler, Color / Q000379:methods*; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D008297:Male; D009200:Myocardial Contraction / Q000502:physiology; D011652:Pulmonary Circulation / Q000502:physiology*; D011667:Pulmonary Veins / Q000000981:diagnostic imaging*; D012189:Retrospective Studies