Circulation, Vol 82, 1127-1139, Copyright © 1990 by American Heart Association
HF Kuecherer, IA Muhiudeen, FM Kusumoto, E Lee, LE Moulinier, MK Cahalan and NB Schiller
To determine whether pulmonary venous flow and mitral inflow measured by
transesophageal pulsed Doppler echocardiography can be used to estimate
mean left atrial pressure (LAP), we prospectively studied 47 consecutive
patients undergoing cardiovascular surgery. We correlated Doppler variables
of pulmonary venous flow and mitral inflow with simultaneously obtained
mean LAP and changes in pressure measured by left atrial or pulmonary
artery catheters. Among the pulmonary venous flow variables, the systolic
fraction (i.e., the systolic velocity-time integral expressed as a fraction
of the sum of systolic and early diastolic velocity-time integrals)
correlated most strongly with mean LAP (r = -0.88). Of the mitral inflow
variables, the ratio of peak early diastolic to peak late diastolic mitral
flow velocity correlated most strongly with mean LAP (r = 0.43), but this
correlation was not as strong as that with the systolic fraction of
pulmonary venous flow. Similarly, changes in the systolic fraction
correlated more strongly with changes in mean LAP (r = -0.78) than did
changes in the ratio of peak early diastolic to peak late diastolic mitral
inflow velocity (r = 0.68). We conclude that in the surgical setting
observed, pulmonary venous flow from transesophageal pulsed Doppler
echocardiography can be used to estimate mean LAP. This technique may
provide a rapid, simple, and relatively noninvasive means of gauging this
variable in patients undergoing intraoperative transesophageal
echocardiography.
ARTICLES
Estimation of mean left atrial pressure from transesophageal pulsed Doppler echocardiography of pulmonary venous flow
Department of Medicine, University of California, San Francisco 94143- 0214.
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