Circulation, Vol 71, 1105-1112, Copyright © 1985 by American Heart Association
G Keren, J Sherez, R Megidish, B Levitt and S Laniado
We studied the physiology of pulmonary venous flow in 13 normal subjects
and five patients with atrial rhythm disorders and atrioventricular
conduction disturbances with pulsed Doppler and two- dimensional
echocardiography. The left atrium, mitral valve, and pulmonary venous ostia
were visualized through the apical four-chamber view. Mitral and pulmonary
venous flows were obtained by placing the Doppler sample volume at the
appropriate orifice. Pulmonary venous flow was biphasic: a rapid filling
wave was observed during systole when the mitral valve was closed; a second
wave was observed in diastole during the rapid ventricular filling phase of
mitral flow, but was significantly delayed. In patients without atrial
contraction (atrial fibrillation and sinoatrial standstill), the initial
rapid filling was greatly diminished and only the second diastolic wave
appeared to contribute to left atrial filling. In patients with high-grade
atrioventricular block, each atrial contraction was followed by a surge in
flow from the pulmonary veins. These results are consistent with data
obtained from invasive measurements in both dogs and man, and confirm the
validity of the use of pulsed Doppler echocardiography in the study of
pulmonary venous flow. We suggest that pulmonary venous flow is influenced
by dynamic changes in left atrial pressure created by contraction and
relaxation of the atrium and ventricle. The initial peak in pulmonary
venous flow occurs with atrial relaxation simultaneously with the reduction
of left atrial pressure, and the second peak occurs with left ventricular
relaxation and rapid transmitral filling of the ventricle.
ARTICLES
Pulmonary venous flow pattern--its relationship to cardiac dynamics. A pulsed Doppler echocardiographic study
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