Transesophageal Pulsed Doppler Echocardiographic Study of Systolic Flow Velocity Patterns of the Pulmonary Vein in Patients with Atrial Fibrillation

Pulmonary venous flow assessed by Doppler echocardiography in the management of atrial fibrillation

Pulmonary venous blood flow (PVF) visualized by Doppler echocardiography exhibits a pulsatile behavior, which is related to left atrial pressure and function, mitral valve function, and left ventricular compliance. In atrial fibrillation (AF), the disappearance of atrial reverse flow, a decrease in systolic flow with a greater diastolic than systolic flow, a prolonged onset of systolic flow and the appearance of an early systolic reverse flow are characteristic findings. A reduction in systolic PVF expressed by reduced peak velocity, reduced velocity-time integral of systolic flow, and reduced systolic fraction of PVF has been found to be associated with reduced left atrial appendage flow, left atrial spontaneous echo contrast formation, frequency of AF paroxysms and propensity for AF recurrence following restoration of sinus rhythm. Ablation techniques targeting pulmonary vein ostia and adjacent left atrium are promising treatment options to cure AF. Monitoring the PVF response to and adjusting of ablation procedures has been suggested to optimize outcome and prevent complications such as pulmonary vein stenosis. In conclusion, assessment of PVF variables and patterns by Doppler echocardiography seems useful in the management of AF patients. Especially the reduction in systolic PVF may be used as marker for left atrial dysfunction which favors thrombus formation and AF reinitiation. Finally, PVF monitoring has the potential to an increasing role in AF ablation procedures.

Normal patterns of flow in the superior caval, hepatic and pulmonary veins as measured using Doppler echocardiography during childhood

To date, no reference values have been provided for right and left atrial filling in normal children. The aim of our study, therefore, was to characterize measurements of superior caval, hepatic, and pulmonary venous flow using Doppler echocardiography in a large group of normal children to reflect the effects of age, body mass index, sex, heart rate and respiration. Doppler echocardiographic examinations of the superior caval, hepatic and pulmonary veins were performed during inspiration and expiration in 72 healthy children with a mean age of 6.73 +/- 5.10 years. The subjects were segregated into four age groups, namely infants < 2 years, preschool children between the ages of 2 and 7 years, children of school age between 7 and 11 years, and adolescents older than 11 years. Age has significant effect on the systolic and reverse atrial flows within the superior caval vein (p < 0.05). No change in the Doppler velocities was observed related to body mass index or sex. All peak systolic velocities decreased significantly during expiration (p < 0.05). This decrease was most prominent in the hepatic vein (26%), but less remarkable in the superior caval vein (5.7%) and the pulmonary veins (3.9%). During expiration, the peak diastolic flow in the superior caval and the hepatic veins decreased, while the reverse atrial flow in the hepatic vein increased (p < 0.05). Pulmonary venous velocities were similar in all age groups (p > 0.05). Except for the systolic pulmonary venous velocities, these parameters were not influenced by respiration (p > 0.05). The diastolic time, the interval between reverse atrial flow and ventricular systole reflected by the R wave on the electrocardiogram, and the interval between ventricular systole and diastolic flow, were negatively correlated with heart rate (p < 0.05; r = -0.35, -0.85, and -0.8 respectively), and positively correlated with age (p < 0.05; r = 0.3, 0.8, and 0.7 respectively). They were not influenced by respiration. Our study provides data of the patterns and the normal ranges of velocities of superior caval, hepatic, and pulmonary venous flow in a series of normal children. The results can now be used for comparison with the patterns found in the setting of disease.

Difference in the respiratory variation between pulmonary venous and mitral inflow Doppler velocities in patients with constrictive pericarditis with and without atrial fibrillation

OBJECTIVES

The goal of this study was to evaluate the difference in the respiratory change from expiration to inspiration (%E) between pulsed Doppler mitral inflow (MV) and pulmonary venous flow (PV) velocities in patients with constrictive pericarditis (CP) and to describe the influence of atrial fibrillation (AF).

BACKGROUND

The difference in %E between MV and PV velocities as well as the influence of AF on %E has not been well described.

METHODS

Pulsed-wave Doppler transesophageal echocardiography (TEE) was performed with respiratory monitoring in 31 patients with CP and sinus rhythm (SR) and in 10 patients with CP and AF. The MV early (E) and late diastolic (A) velocities and their velocity time integral (VTI) as well as PV systolic (S) and diastolic (D) velocities and their VTI were measured.

RESULTS

Regardless of the cardiac rhythm: 1) The MV-E velocity and E-VTI as well as PV-D velocity and D-VTI significantly decreased from expiration to inspiration; 2) the %E in PV-D velocity (27% in SR and 35% in AF) and D-VTI (38% in SR and 45% in AF) was significantly greater than that in MV-E velocity (18% in SR and 15% in AF) and E-VTI (21% in SR and 19% in AF), respectively; 3) the PV S/D and S/D-VTI significantly increased from expiration to inspiration.

CONCLUSIONS

A significant respiratory variation was observed in both MV and PV velocities in CP, not only in patients with SR but also in those with AF. Moreover, the %E was greater in the PV velocities than it was in the MV velocities. Evaluation of the %E in the PV velocities using TEE can be a sensitive diagnostic strategy for evaluation of patients with CP, even in patients with AF.