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Lee, Lee, Kang, Chou, Kim, Kim, Song, and Bae: Patterns of Pulmonary Venous Flow in the Patients with Mitral Stenosis using Transesophageal Echocardiography
Original Article

J Korean Soc Echocardiogr 1995;3(2):144-150.

Published online: 18 February 1995

DOI: https://doi.org/10.3803/jkes.1995.3.2.144

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

Sang-Eog Lee, M.D., Hyo-Jung Lee, M.D., Heung-Sun Kang, M.D., Chung-Whee Chou, M.D., Kwuen-Sam Kim, M.D., Myung-Shick Kim, M.D., Jung-Sang Song, M.D., Jong-Hwa Bae, M.D.

Division of Cardiology, Departement of Internal Medicine, Kyung-Hee University, Seoul, Korea

Copyright © 1995 Korean Society of Echocardiography

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective

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 atrial 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.

Keywords: Pulmonary venous flow, Mitral stenosis.

References

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Fig. 1.
Patterns of transesophageal echocardiographic pulmonary venous flow in the patients of mitral stenosis with sinus rhythm(upper pannel) and atrial fibrillation (lower pannel). S: systolic, D: diastolic, AR: atrial reversal.
jkse-3-144f1.tif
Table 1.
Clinical characteristics of study patients
  Total Sinus rhythm Atrial fibrillation
Number of patients 35 10 25
Male: female 13: 22 5: 5 8: 17
Age(years) 51 ± 13.1 50 ± 6.4 51 ± 1.5
Left ventricular diastolic dimension(mm) 50.5 ± 10.1 49.1 ± 9.1 51.1 ± 0.4
Left ventricular systolic dimension(mm) 37.3 ± 8,1 34.2 ± 9.9 38.5 ± 7.0
Left atrium(mm) 56.7 ± 5.8 53.3 ± 4.8 58.0 ± 5.6∗
Valvular area(cm2) 1.45 ± 0.6 1.72 ± 0.8 1.34 ± 0.5
Mean ressure gradient(mmHg) 17.2 ± 6.8 18.1 ± 6.9 16.8 ± 6.8

∗ : p < 0.05 compared with normal sinus rhythm

Table 2.
Pulmonary venous flow according to cardiac rhythm
  Total Sinus rhythm Atrial fibrillation
Number of patients 35 10 25
Systolic peak velocity(cm/s) 24.9 ± 7.6 27.5 ± 7.0 23.9 ± 7.6
Diastolic peak velocity(cm/s) 27.4 ± 8.6 28.2 ± 9.3 27.1 ± 8.3
Systolic/diastolic ratio 0.99 ± 0.29 1.05 ± 0.29 0.92 ± 0.29
Atrial reversal(cm/s) 16.9 ± 2.8 16.9 ± 2.8 -
Diastolic pressure half time(ms) 71.3 ± 28.1 60.7 ± 23.6 75.5 ± 28.6
Table 3.
Pulmonary venous flows according to mitral valve area
Valve area(cm2) > 1.5(n=8) 1 1.5(n=16) <1.0(n=11)
Systolic peak velocity(cm/s) 30.7 ± 6.4 23.7 ± 6.4∗ 19.3 ± 6.1∗
Diastolic peak velocity(cm/s) 27.8 ± 7.7 25.9 ± 8.9 29.7 ± 8.9
Systolic/diastolic ratio 1.16 ± 0.26 0.97 ± 0.25∗ 0.68 ± 0.20∗
Diastolic pressure half time 72.2 ± 32.7 74.2 ± 27.1 64.4 ± 21.2

∗ : p < 0.05 compared with > 1.5cm2 group

Table 4.
Pulmonary venous flows according to thrombus and spontaneous echo contrast(SEC)
  Thrombus(n=6) No Thrombus(n=6) SEC(n=24)
Systolic peak velocity(cm/s) 25.8 ± 6.5 24.7 ± 6.6 24.8 ± 7.6
Diastolic peak velocity(cm/s) 29.2 ± 8.0 34.3 ± 9.3 25.5 ± 7.8
Systolic/diastolic ratio 0.91 ± 0.28 0.84 ± 0.20 0.84 ± 0.20
Diastolic pressure half time(ms) 70.9 ± 43.2 65.8 ± 22.2 65.8 ± 22.2
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