Application of abdominal venous Doppler flow pattern in volume management / 中华危重病急救医学

Accurate assessment of hemodynamic status is crucial for volume management. Venous congestion caused by volume overload can cause organ damage and poor prognosis. Traditional critical ultrasound, including inferior vena cava ultrasound, echocardiography, and lung ultrasound, is widely used in volume management. However, it is unable to evaluate the organ blood flow. The blood flow pattern of abdominal vein changes dynamically with venous congestion, which is an index for evaluating the blood flow of hepatic vein, portal vein and internal renal vein by Doppler ultrasound. This article reviews the acquisition and grading standards of abdominal venous blood flow patterns, their application and limitations in volume management, with a view to providing help for early clinical identification of terminal organ congestion, implementation of fluid negative balance intervention and individualized volume management.

Alteration of Pulmonary Venous Flow Doppler Post Transcatheter Closure of Atrial Septal Defect

Background: Atrial septal defect is a common congenital heart anomaly results in hemodynamically significant right ventriclular volume overload and an increase in the pulmonary venous flow. Aim: Evaluate changes of pulmonary venous flow parameters after transcatheter closure of secundum atrial septal defect. Patients and Methods: 50 patients with atrial septal defect aged from 3.5 to 31 years were included in the study. Pulmonary venous flow Doppler and right ventricular function were evaluated before and after successful transcatheter closure by transthoracic and transesophageal echocardiography. Results: The defect size ranged from 15 to 37mm with a mean (24.96 ±7.52), Normal systolic and diastolic waves of pulmonary venous flow Doppler were replaced by a continuous antegrade wave (mean 60±13.6 cm/s) in all atrial septal defect patients. Post-closure, the normal pulmonary venous flow pattern was regained, two separate waves, with a significant decrease in mean peak Systolic wave velocity (44.54±8.12 cm/sec vs 69.61±12.37, P=0.000), the mean peak Diastolic Wave velocity (55.85±9.81 cm/sec vs 72.65±10.38, P=0.000) and a significant increase in the mean peak atrial reversal wave velocity (28.75±4.63cm/sec vs 21.18±3.64, P=0.000). In multivariate regression analysis, significant predictors of haemodynamic significant ASD were ASD size,(odds ratio 1.508, P=0.007, 95% CI 1.153,2.671) and ASD/IAS ratio (odds ratio 2.313, P=0.001, 95% CI 1.064,3.104). Conclusions: Atrial septal defect patients have characteristic pulmonary venous flow pattern: continuous antegrade wave with systolic predominance and decrease in atrial reversal wave, which return to normal after closure. These changes could be helpful echocardiographic tool in prediction of successful closure of the defect.

Doppler ultrasound testing suggests hemorrhoids in females may be a consequence of impaired blood flow Associated with pelvic organ prolapse

Abstract Background It has been observed that there is a high incidence of hemorrhoids in female patients with pelvic organ prolapse. Also, in these patients, hemorrhoidal disease improves after the surgical correction of the pelvic organ prolapse. Objective Our hypothesis was that a cause-effect relationship between pelvic organ prolapse, and hemorrhoids might be the key. The objective of this study was to find an element which connects these two conditions. Study Design We conducted a pilot study which consisted of two parts. An initial part, in which we asked several patients with grades III and IV pelvic organ prolapse and hemorrhoids, who have undergone surgery for prolapse, to determine the impact of the surgical restoration of the prolapsed organs on their hemorrhoidal disease. For the second part, on several patients with uncorrected uterine prolapse grades III and IV, we determined the resistive index of the hemorrhoidal branches within the rectal wall before and after manual reduction of the prolapse. Results First, more than 50% of patients who underwent uterine prolapse correction described an improvement of their hemorrhoidal disease of over 50%. Second, the resistive index of the hemorrhoidal branches was significantly lower after manual reduction of the prolapse. We consider that obstructed veins due to pelvic organ prolapse might induce the dilation of the hemorrhoids. The direct measurement of the resistive index of the hemorrhoidal branches allows us to directly assess the increased resistance in the rectal vascular system. Conclusion Venous stasis and impaired vascular flow might be the pathophysiological explanation for the association between pelvic organ prolapse and hemorrhoids. In these patients, the pathogenic treatment should aim at the restoration of a normal blood flow (prolapse surgical cure) instead of focusing on hemorrhoids only.(AU)

Study of the ratio of normal fetal umbilical venous blood flow rate to umbilical artery pulsatility index / 中华超声影像学杂志

Objective:To establish the normal reference range of the ratio of fetal umbilical venous flow rate to umbilical artery pulsatility index (VAI).Methods:A total of 816 normal fetuses underwent prenatal examination and delivery were randomly selected from October 2018 to December 2020 in Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region. Fetal weight was obtained by measuring fetal biparietal diameter, head circumference, abdominal circumference, and femoral length.Umbilical venous flow (Quv) was measured. Umbilical artery pulsatility index (UA-PI) was obtained in the free segment of amniotic fluid. Quv was standardized according to fetal size to calculate the umbilical venous flow rate (nQuv) and VAI. The association between Quv, nQuv, UA-PI, VAI and the fetal gestational week were analyzed using correlation analysis. VAI was presented as ± s, the upper limit of 95% reference value and the lower limit of 5% reference value were taken as the standards of VAI increase and decrease, respectively. Twenty-six fetuses whose VAI were lower than limit of 5% and 20 fetuse whose VAI were than limit of 95% were chosed as the case group. Results:①Fetal Quv was positively correlated with gestational week ( r=0.893, P<0.001), nQuv and UA-PI were negatively correlated with gestational week ( r=-0.552, -0.827; all P<0.001), and VAI had no significant correlation with gestational week ( r=0.000, P=0.758); ②The mean, standard deviation, lower 5% reference value, and upper 95% reference value of VAI were 195.81, 55.61, 105.95, and 293.33, respectively; ③In the cases with abnormal VAI, 26 fetuses with reduced VAI, of whom there were 16 cases of maternal hypertension, and 13 cases complicated by severe preeclampsia; 1 case with 40 turns of umbilical cord torsion, 3 cases of stillbirth, 16 cases of preterm delivery, 19 cases of low neonatal birth body weight, 4 cases of 1-min Apgar score ≤7, 6 cases of umbilical artery blood pH<7.2, and 1 case without abnormalities in fetus during pregnancy and follow-up newborn. Among the 20 fetuses with increased VAI, there were 10 cases of fetal severe thalassemia, 2 cases of thalassemia, 1 case of sacrococcygeal teratoma, 1 case of portal venous shunt, 3 cases of placental chorioangioma, and 3 cases without abnormalities in fetus during pregnancy and follow-up newborn. Conclusions:The measurement and calculation of fetal VAI is simple and easy to perform. As a comprehensive index, fetal VAI remains constant in mid and late pregnancy, facilitates the follow-up of abnormal fetuses, and has potential clinical application.

Application of venous flow-through flap in complex finger replantation / 中华显微外科杂志

Objective To analyze the outcome of applying venous flow-through flap in replantation of complex severed finger.Methods From March,2011 to August,2012,15 cases of complex severed fingers were repaired by flow-through flap with two sets of venous system of forearm vein and one stage repair of wound.The time from injury to operation was 1.5-5.5 h (mean 2.5 h).Vascular defect length ranged from 1.5 to 11.0 cm (mean 3.6 cm);and soft tissue defect of 1.5 cm × 3.0 cm to 11.0 cm × 11.0 cm.All digits had severe soft tissue defect and segmental defect of blood vessels.All the finger blood circulation was disorder.Results All flaps and replanted fingers survived completely,except 1 case of postoperative venous crisis occurred which was remission after the vascular transplantation,and 1 case of skin flap necrosis at the distal part which was healed after skin grafting; Fourteen cases were followed-up from 7 to 20 months.At the final followed-up the flaps were of good consistency and appearance.Function of the finger was graded excellent in 7 cases,good in 5 cases,and poor in 2 cases.All flaps and replanted fingers survived completely over a period of 12 to 30 months follow-up.The flaps were of good consistency and appearance.Function of the finger was graded excellent in 7 cases and good in 5 cases.Conclusion With less injury at donor site,and good repair results,venous flow-through flap is well indicated in complex finger replantation with soft tissue defect and vascule defect.

Utility of pulmonary venous flow diastolic deceleration time in an adult patient undergoing surgical closure of atrial septal defect and coronary artery bypass grafting.

Acute left ventricular (LV) failure has been reported after surgical closure of atrial septal defect (ASD) in adult patients. We report acute LV failure in a 56 year old gentleman following coronary artery bypass grafting (CABG) and surgical closure of ASD. Transesophageal echocardiography examination of the patient following closure of ASD and CABG showed a residual ASD and a shunt (Qp :Qs = 1.5). The residual ASD was closed after re-institution of cardiopulmonary bypass (CPB) under cardioplegic cardiac arrest. However, the patient did not tolerate closure of the residual ASD. The CPB was re-established and under cardioplegic cardiac arrest residual ASD was reopened to create a fenestration. This time patient was weaned easily from CPB. Postoperatively, 16 hours after extubation, patient became hemodynamically unstable, the patient was electively put on ventilator and intra-aortic balloon pump. Later the patient was weaned off successfully from ventilator. Retrospective analysis of pulmonary venous flow diastolic deceleration time (PVDT D ) recorded during prebypass period measured 102 msec suggestive of high left atrial pressure which indicate possibility of LV failure after ASD closure.

Early Diagnosis and Management of Cerebral Venous Flow Obstruction Secondary to Transsinus Fracture after Traumatic Brain Injury

BACKGROUND AND PURPOSE: Cerebral venous flow obstruction (CVFO) is a fatal complication of traumatic brain injury. To compare the outcomes of patients with CVFO secondary to traumatic-brain-injury-induced transsinus fracture who were diagnosed early versus those diagnosed late in the therapeutic course. METHODS: In total, 403 patients with transsinus fracture were reviewed retrospectively. The patients were divided into an early-diagnosis group (n=338) and a delayed-diagnosis group (n=65). The patients submitted to 2D time-of-flight magnetic resonance venography (2D-TOF MRV) and/or CT venography (CTV), depending upon the findings of intracranial pressure monitoring, in order to identify potentially complicated CVFO. These examinations took place within 3 days of the onset of malignant intracranial hypertension symptoms in the early-diagnosis group, and after an average of 7 days in the delayed-diagnosis group. Once diagnosed, patients received intravenous thrombolytic therapy with low-dose urokinase. Patients with massive transsinus epidural hematoma, depressed fracture, or cerebral hernia were treated surgically to relieve the compression and repair any damage to the venous sinuses. RESULTS: Cerebral venous flow obstruction was much more severe in the delayed-diagnosis group than in the early-diagnosis group (p<0.001), and hence patients in the former group were given a higher dose of urokinase (p<0.001) for thrombolytic therapy. They were also significantly more likely to need surgery (48.1% vs. 20.6%, p=0.003) and had a higher mortality rate (37.0% vs. 4.1%, p<0.001). However, patients in both groups experienced a similarly favorable prognosis, not only with regard to functional outcome but also with respect to neuroradiological improvement, as evaluated by 2D-TOF MRV/CTV at the final follow-up (p=0.218). CONCLUSIONS: Delayed diagnosis can result in increased risk of surgery and death in the acute phase. Thrombolytic therapy with low-dose urokinase resulted in promising improvements in both functional and neuroradiological outcomes in all of the patients in this study, regardless of the time to diagnosis.

Cambios en el flujo venoso de miembros inferiores en pacientes hospitalizados con patologías médicas / Changes in lower limb venous flow in hospitalized patients with medical conditions

La Enfermedad TromboembólicaVenosa (ETV), es diagnosticada muchas veces tardíamente. La mayoría de los casos han sido reportados en pacientes con patologías médicas e inmovilización prolongada. Determinar la relación entre la inmovilización prolongada como factor de riesgo para ETV y su influencia real en el flujo venoso y, los biomarcadores aceptados (Dímero-D). Estudio de cohorte, prospectivo, longitudinal, observacional, de corte transversal, en hospitalizados por patologías médicas, con medición de la velocidad del flujo venoso en miembros inferiores, usando ultrasonografía doppler, correlacionado con el tiempo de inmovilización y niveles de Dímero D a los días 1 y 4 de hospitalización en el Hospital Militar “Dr. Carlos Arvelo”, Caracas, Venezuela. Se obtuvo disminución del flujo venoso de un 20,51± 15,93% al cuarto día (p=0,0002). No se encontró relación entre las variables de disminución en la velocidad de flujo con Dímero D ni con el tiempo de inmovilización. Colateralmente, en las enfermedades metabólicas se presentó disminución marcada del flujo venoso (38,05 ± 10 03%, p=0,003). En el cuarto día de hospitalización se encontraron cambios que pudieran favorecer la aparición de ETV, independientes del tiempo de inmovilización y de los niveles de dímero D; La presencia de enfermedad metabólica o infecciosa se presentó con cambios en el flujo venoso, como un factor de riesgo para ETV

The diagnosis of Venous Thromboembolic Disease (VTD) is often delayed . Most cases have been reported in patients with medical conditions and prolonged immobilization. To determine the relationship between prolonged immobilization as a risk factor for VTD and its influence in venous flow and D- dimer. A prospective, observational study in patients who were hospitalized due to medical conditions, in whom venous flow was measured by Doppler ultrasound and D-dimer on days 1 and 4 of admission. Venous flow was diminished 20,5±15,9 % on day 4 (p= 0,0002). No relationship was found with D-dimer or time of immobilization. In patients who had metabolic and infectious diseases venous flow was markedly diminished (38,05 ± 10 03%, p=0,003.) On the 4th day of hospitalization we found changes that could be a risk factor for VTD independently of the immobilization period or D- Dimer levels. The presence of some metabolic or infectious diseases showed changes in venous flow as risk factor for VT

Serial Monitoring of Portal Venous Pressure/Flow during Living Donor Liver Transplantation

PURPOSE: Although living donor liver transplantations (LDLTs) are widely performed, a shortage of living donors exists continuously, which makes it difficult to find the optimal graft. A high portal venous pressure (PVP) is mainly related to small for size syndrome (SFSS), and low portal venous flow (PVF), to ischemic liver damage, leading to potential liver failure after surgery. We reviewed the literature in search of optimal PVP and PVF values during LDLTs, and tried to determine the clinical meaning of measurements of PVP and PVF for liver transplantation. METHODS: Between June, 2008 and June, 2009, we did 38 LDLTs. PVP and PVF were measured in 13 patients after laparotomy, after implantation of graft and after splenectomy. In addition, compliance (PVF/PVP) and compliance (mL/min/mmHg/g) per unit graft weight were calculated. Splenectomy was done when continuously maintained portal hypertension (>20 mmHg) occurred even after implantation. Splenectomy was also done for patients who presented preoperatively with splenomegaly and pancytopenia. RESULTS: After graft implantation, portal venous pressure decreased (16.8+/-4.1 mmHg vs. 14.7+/-3.1 mmHg)(p=.003), whereas portal venous flow increased (1236.4+/-725.3 mL/min vs. 1916.9+/-603 mL/min)(p=.019). Also, after splenectomy, portal venous pressure/flow decreased (16.4+/-3.7 mmHg vs. 13.8+/-3.3 mmHg)(p=.009)/(2136.4 mL/min vs. 1619.1+/-336.3 mL/min) (p=.001). Finally, after implantation, compliance increased (60+/-40 mL/min/mmHg vs. 126+/-18 mL/min/mmHg)(p=.007). CONCLUSION: After splenectomy, compliance remained constant (126+/-18 mL/min/mmHg vs. 122+/-34 mL/min/mmHg)(p=.364). After implantation of the graft, portal pressure decreased and portal venous flow increased. The compliance of the graft was not influenced by splenectomy. This shows that splenectomy is a good method to control high portal pressure without influencing the compliance of the graft.

Evaluation of Pulmonary Venous Flow Pattern in Atrial Septal Defect and Mitral Stenosis by Transesophageal Echocardiography / 中国医师杂志

Objective To investigate the pulmonary venous flow pattern (PVFP) in atrial septal defect (ASD) and mitral stenosis (MS),to analyze the differences of PVFP in each group and evaluate their clinical value. Methods The characteristics of PVFP and mitral valve flow pattern in 42 patients of ASD and 17 patients of MS were prospectively compared by transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE), and also compared with the normal subject. Result The PVFP was significantly different between MS and ASD, including S、D、Ar、S-T (P

Low Intensity Exercise Dose not Repress the Increase in Portal Venous Flow After a Feeding / 体力科学

It is generally accepted that exercise induces a decrease in splanchnic circulation, because of the increase of blood in working skeletal muscle. On the other hand, ingestion of a meal increases blood flow in splanchnic circulation. However, it remains to be clarified whether splanchnic circulation decreases due to exercise after ingestion of a meal. The present study examined the effect of different intensities of cycling exercise after ingestion of a carbohydrate-drink on portal venous blood flow, blood glucose, serum insulin and plasma catecholamine concentrations. Six volunteers ingested 200 ml of martodextrine solution (12%) [M (200) ] before 20 min exercise sessions of 30% maximal oxygen uptake (VO<SUB>2</SUB>max) and 60% VO<SUB>2</SUB>max. Before and after the exercise sessions, portal venous blood flow was measured by a combined ultrasonic system of an electronic sector scanner and pulsed Doppler flowmeter. Portal venous blood flow in the exercise at 30% VO<SUB>2</SUB>max increased due to the M (200) ingestion. However, a decrease in portal blood flow resulting from exercise at 60% VO<SUB>2</SUB>max was observed in spite of a M (200) ingestion compared with portal blood flow after both rest and the exercise at 30% VO<SUB>2</SUB>max. Immediately after exercise, an increase in blood glucose and serum insulin level was shown for 30% VO<SUB>2</SUB>max with M (200), but not 60% VO<SUB>2</SUB>max. In addition, plasma epinephrine concentration after taking M (200) did not increase as a result of either exercise intensity.<BR>These results suggest that the response of portal venous blood flow caused by carbohydratedrink ingestion immediately before exercise is influenced by exercise intensity, and it corresponds to the changes in blood glucose, serum insulin and plasma epinephrine. We concluded that ingestion of food, rather than exercise, has a regulatory action in splanchnic circulation in low intensity exercise.

Doppler Indexes of Pulmonary Venous Flow Predict Death after Acute Myocardial Infarction

BACKGROUND: Restrictive left ventricular (LV) filling patterns after acute myocardial infarction (AMI) predict poor prognosis. Doppler indexes of LV inflow, especially peak velocity ratio of early versus late diastolic flow (E/A) and deceleration time, can predict heart failure or death. Doppler indexes of pulmonary venous flow are also used to diagnose restrictive LV filling, but their prognostic values after AMI are not known. METHODS: Doppler echocardiographic examination were performed in patients with AMI (n=122) between 7 to 10 days after attack, and followed for 30 months. Death group included 9 deaths (7.4%) during follow-up. 18 age-matched patients (control group) were selected from 70 patients without death, heart failure or readmission. Doppler echocardiographic indexes of peak systolic velocity (SV), peak diastolic velocity (DV), and peak reverse flow velocity associated with atrial contraction (AR) of pulmonary venous flow were measured by transthoracic echocardiography. RESULTS: Death group had lower SV (46.1+/-6.3 vs 57.0+/-14.7 cm/sec; p=0.059) and SV/DV ratio (1.26+/-0.50 vs 1.58+/-0.37; p=0.076). Death group had significantly more patients with SV/DV ratio less than 1.3 (67% vs 17%; p=0.026). AR was significantly different between death and control groups (29.7+/-7.8 vs 24.7+/-6.8 cm/sec; p=0.023). Death group had significantly more patients with AR greater than 25 (78% vs 33%; p=0.046). CONCLUSION: SV/DV ratio and AR of pulmonary venous flow predicted death after AMI.

Analysis of the Doppler Pulmonary Flow Velocity and Mitral Flow Velocity Pattern in Hypertensive Hearts

OBJECTIVES: Hypertension provokes left ventricular diastolic dysfunction due to decreased elasticity of the ventricular myocardium at first. It has been proposed that the Doppler echocardiography might provide information concerning diastole because of its ability to measure the blood flow velocities across the mitral valve noninvasively. But Doppler mitral velocity may be "normalized" in hypertensive patients in different conditions. The purpose of this study is to evaluate diastolic function in hypertensive hearts using Doppler echocardiography of the pulmonary venous flow in conjunction with mitral flow velocity pattern. METHODS: We measured the mitral flow velocity curves and the pulmonary flow velocity curves in fifty hypertensive patients(mean age : 56.3+/-10.0, man : 19, woman : 31) nad forty healthy adults(mean age : 51.6+/-12.5, man : 14, woman : 26) from March 1995 to December 1995 by using the SONO 1000 of Hewlett Packerd. RESULTS: 1) The mitral flow velocity pattern in 50 hypertensive patients was characterized by the decrease in the peak early diastolic filling velocity(E : 0.59+/-0.12m/sec) and the ratio of E to peak filling velocity(A : 1.00+/-0.46m/sec). Isovolumetric relaxation time and deceleration time were 127.2+/-33.3msec, 258.9+/-40.9msec respectively. They were longer than normotensive patients(P < 0.05). 2) The pulmonary venous flow velocity pattern in hypertensive patients was characterized by the decreased peak diastolic forward velocity(D : 33.7+/-9.8cm/sec) and the ratio of peak systolic forward velocity(S) to D(S/D : 1.60+/-0.5)(P < 0.05). 3) There was no relation between the flow velocity integral parameters and the peak flow velocity parameters of pulmonary venous flow pattern in hypertensive patients. 4) The dofference in the pulmonary venous duration and the mitral A wave duration at atrial contraction (DA-DR) was 20.9+/-29.4 msec in hypertensive patients. DA-DR in normatensive patients was 24.3+/-32.9msec. DA-DR was not significant in hypertensive patients compared with that of the healthy subjects (P < 0.05) CONCLUSION: Analysis of pulmonary venous flow velocity pattern in conjunction with mitral flow velocity pattern in hypertensive patients provides more accurate assessment of left ventricular diastolic function.

Patterns of Pulmonary Venous Flow in the Patients with Mitral Stenosis using Transesophageal Echocardiography

OBJECTIVES: In mitral stenosis, there is an alteration of normal left atrial hemodynamics because the narrowed mitral valve prolongs the decay in diastolic pressure, and atrial function may be impaired secondary to atrial fibrillation. In this study, we purposed to evaluation of the pulmonary venous flow patterns in the patients with mitral stenosis using transesophageal echocardiography. METHODS: The study was performed on 35 patients(13 men and 22 women, mean age 51±13.1 years) with mitral stenosis. We measured the left ventricular end-diastolic and end-systolic dimension, left atrial dimension, mitral valve area by planimetry method and the mean pressure gradient by transthoracic echocardiography. Systolic and diastolic peak velocities, atrial reversal and diastolic pressure half time of pulmonary venous flow by transesophageal echocardiography were evaluated. RESULTS: 1) The pulmonary venous peak systolic and diastolic flow velocities were 27.5±7.0cm/sec, 28.2±9.3cm/sec in patients with sinus rhythm, and 23.9±7.6cm/sec, 27.1±8.3cm/sec in patients with artial fibrillation. But there was no difference between patients with sinus rhythm and with atrial fibrillation. 2) The lesser mitral valve area, the more decreased peak systolic velocity and systolic to diastolic flow ratio. Especially, the systolic to diastolic flow ratio was significantly decreased(1.16±0.26, 0.95±0.23, 0.68±0.20, p < 0.05). But there was no difference at the peak diastolic velocity. 3) The thrombus or spontaneous echo contrast in the left atrium was not influence on the pulmonary venous flow pattern. CONCLUSION: In mitral stenosis, systolic flow and systolic to diastolic flow ratio decrease with the decrease of mitral valve area and diastolic flow becomes predominant, which may be useful in assessing the hemodynamics of mitral stenosis.

Comparison of Right and Left Pulmonary Venous Flow Pattern in Several Cardiac Diseases

BACKGROUND: Doppler echocardiographic assessment of pulmonary venous flow has helped to characterize left ventricular diastolic function in various cardiac diseases of the heart. Abnormal pulmonary venous flow patterns have been described for a variety of conditions including restrictive myocardial disease such as cardiac amyloidosis, constrictive pericarditis,, dilated cardiomyopathy and they also helped to assess the severity of mitral regurgitation. Therefore this study was designed to evaluate the changes of pulmonary venous flow profiles in several cardiac diseases which are commonly encountered clinically, such as congestive heart failure, mitral regurgitation, mitral stenosis, aortic regurgitation and left ventricular hypertrophy and also the differences between right and left pulmonary venous flow pattern in these conditions. METHOD: We analyzed transesophageal echocardiographic findings of 328 patients(95 men and 233 women, mean age 54±13 years) in those right and left pulmonary venous flow were obtatinable. According to the echocardiographic findings, the above subjects were calssified into control group(n=167), conestive heart failure group(n=23), mitral regurgitation group (n=28), mitral stenosis group(n=10), aortic regurgitation group(n=37), and left ventricular hypertrophy group(n=23). In this study, the datas of subjects who did not show significant valvular lesions, ventricular hypertrophy, systolic or diastolic dysfuction were used as a control. Peak systolic velocity(peak S), systolic velocity integral(syst. V.I), peak diastolic velocity(peak D), diastolic velocity integral(dias. V.I.), peak velocity of atrial contraction(peak A), velocity integral of atrial contraction(A. V.I.), peak systolic velocity/peak diastolic velocity ratio(peak S/peak D), and systolic velocity integral/diastolic velocity integral ratio(syst./dias V.I) were measured in each group. RESULTS: The pulmonary venous flow pattern of right and left pulmonary vein in each group and comparisons between different groups showed the findings as follows(table). CONCLUSION: Analysis of pulmonary venous flow could be used as a useful index of evaluating diseased state of heart. Each group showed the relatively characteristic changes of pulmonary venous flow and those changes could be observed commonly in both right and left pulmonary vein. When one side of pulmonary veins could not be evaluated adequately, the valuable hemodynamic information could be obtained through the examintion of the other side pulmonary vein.

Transesophageal Echocardiographic Evaluation of Pulmonary Venous Flow Patterns before and after Percutaneous Mitral Commissurotomy

BACKGROUND: Pulmonary venous flow(PVF) is closely related to left atrial pressure(LAP) and percutaneous mitral commissurotomy(PMC) reduces LAP rapidly. However, PVF pattern in mitral stenosis(MS) with sinus rhythm after PMC remains to be elucidated. METHODS: Transesophageal echocardiographic pulsed Doppler examination was performed within 24 hours before and after PMC to evaluate PVF pattern in 10 patients of MS with sinus rhythm. RESULTS: Before PMC, both peak velocity(PV) and velocity time integral(VTI) during systole had significant negative correlations with mean LAP(r=-0.70, r=-0.79, respectively). After PMC, both systolic PV and VTI increased significantly without significant changes in diastolic PV and VTI. However, there was no significant correlation between systolic PV and mean LAP, and between systolic VTI and mean LAP after PMC. CONCLUSION: In mitral stenosis with sinus rhythm, these data suggest that systolic PVF decreases with increase of mean LAP and PMC could reverse this change without affecting diastolic PVF. However, acute hemodynamic changes of left atrium induced by PMC may contribute to the absence of correlation between mean LAP and systolic PVF after PMC.

Pulmonary Venous Flow Pattern by Color Doppler Echocardiography in Childhood

BACKGROUND: Biphasic or triphasic or quadriphasic pattern of pulmonary venous flow has been described by color Doppler echocardiography in normal subjects. Absolute velocity measurements varied with the position of the probe in relation to the pulmonary vein. The purpose of this study is to evaluate the normal pulmonary venous flow pattern and compare the data according to age, body weight, height and body surface area. METHODS: 244 normal children underwent transthoracic echocardiography from December 1992 to July 1993. Age ranged from newborns to 13 years. From the apical four chamber view, pulmonary venous flow velocity and integral were obtained. RESULTS: Quadriphasic pulmonary flow pattern(early systolic flow, late systolic flow, diastolic flow, atrial reversal flow) was identified. Pulmonary venous peak flow velocity was not different according to increasement of age, body weight, height or body surface area. But pulmonic flow integral was significantly increased according as increasement of age, body weight, height, or body surface area. CONCLUSION: Transthoracic color Doppler echocardiography is a good noninvasive diagnostic tool to evaluate pulmonary venous flow pattern in children.

Transesophageal Echocardiographic Evaluation of Pulmonary Venous Flow in Mitral Stenosis

BACKGROUND: Normally major forward pulmonary venous flow(PVF) into left atrium occurs during systole and early diastole. This is followed by the reversal of the PVF with atrial contraction during late diastole. Chronic increase of left atrial pressure and volume, and decrease of the left atrial compliance might alter the PVF pattern in patients with mitral stenosis. Moreover, the cardiac rhythm could be changed from sinus rhythm(SR) to atrial fibrillation(AF) with the progression of the disease. To elucidate the effect of these changes on PVF, we performed transesophageal echocardiographic(TEE) Doppler examination in 20 patients of mitral stenosis who were going to be taken Percutaneous mitral commissurotomy(PMC). METHOD: We measured the velocities of the PVF by TEE pulsed Doppler examination, and compared it with the hemodynamic parameters measured by cardiac catheterization in 20 patients of mitral stenosis who underwent the PMC. The SR was found in 12 patients and the rest showed established AF. RESULTS: 1) Doppler variables measured by TEE. 2) Hemodynamic parameters measured by cardiac catheterization. 3) In patients with SR, S-PV, S-VTI and S-FVTI showed negative correlation with mean LAP(r=-0.66, -0.67, -0.71, respectively, p<0.05). However in AF group, there is no correlation between Doppler variables and mean LAP. CONCLUSION: In mitral stenosis with SR, systolic PVF decreases with the increase of mean left atrial pressure and finally, diastolic PVE becomes predominant with the development of AF.

Effects of percutaneous mitral valvuloplasty on pulmonary venous flow velocities in patients with mitral stenosis

BACKGROUND: Recent development of transesophageal echocardiography(TEE) makes it possible to record pulmonary venous flow velocities(PVFV) accurately. To observe the differences of PVFV between normal controls and patients with severe mitral stenosis and to clarify the effects of percutaneous mitral valvuloplasty(PMV) on PVFV, TEE was performed in 12 normal controls and 11 patients with severe mitral stenosis. METHODS: PVFV was recorded from left upper pulmonary vein in longitudinal view of midesophageal position with a 5 MHz probe. Peak velocity and velocity-time integral(VTI) of systole and diastole were calculated with a digitizer. TEE was performed before and one day after PMV. Hemodynamic data(left atrial pressure, transmitral diastolic pressure gradient and cardiac output) were analyzed to demonstrate the possible correlation with PVFV. RESULTS: 1) 75%(9/12) of normal controls showed 4 distinct phases of PVFV with 2 systolic forward peaks, I diastolic forward and I end-diastolic backward peak. Peak systolic velocity was 52.6+/-.9cm/sec and peak diastolic forward velocity was 36.0+/-10.3cm/sec : Systolic VTI was greater than diastolic VTI, too(11.1+/-3.6cm vs 5.2+/-.6cm). 2) In patients with tight mitral stenosis(mean mitral area : 0.9cm2), most(10/11, 91%) showed one peak of systolic forward flow : Peak systolic velocity(27.8+/-15.8cm/sec) and systolic velocity-time integral(3.4+/-1.8cm)were significantly smaller than those of normal controls, while there was no statistical difference in peak diastolic forward velocity and velocity-time integral(34.5+/-12.7cm/sec, 4.3+/-1.7cm) compared to normal controls. There were no significant differences according to the rhythm. After successful PMV(mean mitral valve area : 1.9cm2) peak systolic and diastolic velocities increased up to 46.9+/-13.8cm/sec, 41.4+/-7.5cm/sec respectively, and systolic increase was statistically significant. The systolic increase of peak pulmonary venous velocity and velocity-time integral was more prominent in normal sinus group compared to patients with atrial fibrillation. 3) In patients with mitral stenosis, there was no correlation between peak diastolic forward velocity of pulmonary vein and peak transmitral early diastolic velocity(r=-0.19, p=0.40) : There was a weak negative correlation between mean left atrial pressure and peak systolic velocity of pulmonary vein(r=-0.46, p=0.03) in the pooled data of pre- and postvalvuloplasty(N=22). Also there noticed a negative correlation between diastolic transmitral pressure gradient and peak diastolic velocity of pulmonary vein(r=-0.49, p=0.02, N=22). CONCLUSION: Pulmonary venous velocities of patients with tight mitral stenosis showed decreased peak systolic velocity and VTI due to increased left atrial pressure and decreased compliance. which normalized immediately after successful PMV. In patients with mitral stenosis there seems to be somewhat different relationships between hemodynamic indices and pulmonary venous flow velocities, and further study with more patients with variable mitral valve area would be necessary to clarify the exact correlation.

The Pattern of Pulmonary Venous Flow in Various Heart Disease

To evaluate the influencing factors on pulmonary venous flow(PVF) pattern, we studied the relationship between PVF and left ventricular ejection fracton(EF), mitral annulus motion(MAM) and transmitral flow using pulsed doppler echocardiography in patients with dilated cardiomyopathy(DCMP), acute myocardioal infarction(AMI), left ventricular hypertrophy(LVH) and atrial fibrillation(AE). Ther results were as follows : 1) In the normal controls(13 cases), two forward flow during ventricular systole(VS) and diastole(VD) and one retrograde flow during atrial systole(AS) were observed. The peak velocity of VS, VD and AS flow was 45.9cm/s, 42.8cm/s and -18.3cm/sec, respectively. The peak VS/VD ratio was 1.1. 2) In patients with DCMP(11 cases), (a) compared to the noraml subjects, the peak velocity of VS flow and VS/VD ratio were were significantly reduced(p<0.005 and p<0.001, respectively) and were positively correlated with ejection fraction(r=0.8 and r=0.7, respectively) (b) in 2 DCMP cases with severe mitral regurgitation, systolic retrograde flow was observed in the pulmonary vein instead of forward VS flow. 3) In 12 AMI cases and 7 LVH cases with normal or slightly diminished left ventricular systolic function but with abnormal diastolic function. (a) the peak velocity of VS flow and peak VS/VD ratio were significantly increased(r<0.005 and p<0.01, respectively). (b) the peak velocity of VD flow is positively correlated with transmitral E/A ratio(r=0.8) and the peak VS/VD ratio was positively correlated with transmitral pressure half time(r=0.8). (c) the peak velocity of retrograde AS flow was significantly increased(p<0.001). (d) there was no correlation between doppler parameters of PVF and left ventricular ejection fraction. 4) In patients with atrial fibrillation(10 cases), VS flow was markedly diminished or absent and only VD flow was observed. Also, retrograde AS flow was not observed. These findings suggest that the pattern of PVF is influnced by LVEF, MAM, transmitral inflow and atrial contraction. However, main contributary factors in determining the pattern of PVF in each disease are diverse according to its main pathophysiology.