Doppler echo evaluation of pulmonary venous-left atrial pressure gradients: human and numerical model studies

2000 ◽  
Vol 279 (2) ◽  
pp. H594-H600 ◽  
Author(s):  
Michael S. Firstenberg ◽  
Neil L. Greenberg ◽  
Nicholas G. Smedira ◽  
David L. Prior ◽  
Gregory M. Scalia ◽  
...  
Keyword(s):  
Numerical Modeling ◽  
Left Atrial ◽  
Atrial Pressure ◽  
Left Atrial Pressure ◽  
High Fidelity ◽  
Pressure Gradients ◽  
Bernoulli Equation ◽  
Venous Flow ◽  
Model Studies ◽  
Pulmonary Venous Flow

The simplified Bernoulli equation relates fluid convective energy derived from flow velocities to a pressure gradient and is commonly used in clinical echocardiography to determine pressure differences across stenotic orifices. Its application to pulmonary venous flow has not been described in humans. Twelve patients undergoing cardiac surgery had simultaneous high-fidelity pulmonary venous and left atrial pressure measurements and pulmonary venous pulsed Doppler echocardiography performed. Convective gradients for the systolic (S), diastolic (D), and atrial reversal (AR) phases of pulmonary venous flow were determined using the simplified Bernoulli equation and correlated with measured actual pressure differences. A linear relationship was observed between the convective ( y) and actual ( x) pressure differences for the S ( y = 0.23 x + 0.0074, r = 0.82) and D ( y = 0.22 x + 0.092, r = 0.81) waves, but not for the AR wave ( y = 0.030 x + 0.13, r = 0.10). Numerical modeling resulted in similar slopes for the S ( y = 0.200 x − 0.127, r = 0.97), D ( y = 0.247 x − 0.354, r= 0.99), and AR ( y = 0.087 x − 0.083, r = 0.96) waves. Consistent with numerical modeling, the convective term strongly correlates with but significantly underestimates actual gradient because of large inertial forces.

Relationship of Pulmonary Venous Flow Pattern to Mean Left Atrial Pressure and Phasic Pressure Change

Cardiology ◽  
1996 ◽  
Vol 87 (3) ◽  
pp. 224-229 ◽  
Author(s):  
Jer-Min Lin ◽  
Yi-Heng Li ◽  
Kwan-Lih Hsu ◽  
Juey-Jen Hwang ◽  
Yung-Zu Tseng
Keyword(s):  
Flow Pattern ◽  
Left Atrial ◽  
Pressure Change ◽  
Atrial Pressure ◽  
Left Atrial Pressure ◽  
Venous Flow ◽  
Pulmonary Venous Flow ◽  
Relationship Of

Influence of heart rate and left atrial pressure on pulmonary venous flow pattern in dogs

1994 ◽  
Vol 266 (6) ◽  
pp. H2296-H2302 ◽  
Author(s):  
T. Steen ◽  
B. M. Voss ◽  
O. A. Smiseth
Keyword(s):  
Heart Rate ◽  
Flow Pattern ◽  
Flow Rate ◽  
Left Atrial ◽  
Atrial Pressure ◽  
Left Atrial Pressure ◽  
Mean Flow ◽  
Venous Flow ◽  
Pulmonary Venous Flow ◽  
The Relationship

In six open-chest anesthetized dogs we investigated the effect of heart rate (HR) on the relationship between left atrial pressure (LAP) and pulmonary venous flow (QPV). QPV was measured by ultrasonic transit time during volume loading and right atrial pacing. Consistent with previous studies, we found a negative correlation between LAP and mean flow rate during atrial systole divided by mean flow rate in the R-R interval. However, this relationship was shifted upward by tachycardia. The QPV maximum amplitude divided by mean flow rate in the R-R interval increased with loading but decreased with tachycardia. mean flow rate during ventricular systole divided by mean flow rate during the R-R interval increased with both loading and tachycardia. Regression coefficients for HR and LAP as predictors of these indexes were all significantly different from zero (P = 0.0001). We conclude that HR significantly influences the relationship between the QPV pattern and LAP. This could be a limitation of the pulmonary venous flow pattern as an indicator of left ventricular diastolic function.

Relation Between Pulmonary Venous Flow and Left Atrial Pressure During Percutaneous Mitral Valve Repair With the MitraClip

2018 ◽  
Vol 122 (8) ◽  
pp. 1379-1386 ◽  
Author(s):  
Hiroki Ikenaga ◽  
Atsushi Hayashi ◽  
Takafumi Nagaura ◽  
Satoshi Yamaguchi ◽  
Jun Yoshida ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Valve Repair ◽  
Left Atrial ◽  
Atrial Pressure ◽  
Left Atrial Pressure ◽  
Valve Repair ◽  
Venous Flow ◽  
Percutaneous Mitral Valve Repair ◽  
Pulmonary Venous Flow

ESTIMATION OF MEAN LEFT ATRIAL PRESSURE BY TRANSESOPHAGEAL PULSED DOPPLER OF PULMONARY VENOUS FLOW.

1990 ◽  
Vol 70 (Supplement) ◽  
pp. S277
Author(s):  
I. A. Muhiudeen ◽  
H. F. Kuecherer ◽  
N. B. Schiller ◽  
M. K. Cahalan
Keyword(s):  
Left Atrial ◽  
Atrial Pressure ◽  
Left Atrial Pressure ◽  
Pulsed Doppler ◽  
Venous Flow ◽  
Pulmonary Venous Flow

Influence of lung volume and left atrial pressure on reverse pulmonary venous blood flow

1991 ◽  
Vol 70 (1) ◽  
pp. 447-453 ◽  
Author(s):  
T. Obermiller ◽  
S. Lakshminarayan ◽  
S. Willoughby ◽  
J. Mendenhall ◽  
J. Butler
Keyword(s):  
Lung Volume ◽  
Left Atrial ◽  
Atrial Pressure ◽  
Left Atrial Pressure ◽  
Venous Blood Flow ◽  
Volume Changes ◽  
Venous Flow ◽  
Pressure Transients ◽  
Arterial Blood ◽  
Pulmonary Venous Flow

Infarction of the lung is uncommon even when both the pulmonary and the bronchial blood supplies are interrupted. We studied the possibility that a tidal reverse pulmonary venous flow is driven by the alternating distension and compression of alveolar and extra-alveolar vessels with the lung volume changes of breathing and also that a pulsatile reverse flow is caused by left atrial pressure transients. We infused SF6, a relatively insoluble inert gas, into the left atrium of anesthetized goats in which we had interrupted the left pulmonary artery and the bronchial circulation. SF6 was measured in the left lung exhalate as a reflection of the reverse pulmonary venous flow. No SF6 was exhaled when the pulmonary veins were occluded. SF6 was exhaled in increasing amounts as left atrial pressure, tidal volume, and ventilatory rates rose during mechanical ventilation. SF6 was not excreted when we increased left atrial pressure transients by causing mitral insufficiency in the absence of lung volume changes (continuous flow ventilation). Markers injected into the left atrial blood reached the alveolar capillaries. We conclude that reverse pulmonary venous flow is driven by tidal ventilation but not by left atrial pressure transients. It reaches the alveoli and could nourish the alveolar tissues when there is no inflow of arterial blood.

Improvement in diastolic intraventricular pressure gradients in patients with HOCM after ethanol septal reduction

2003 ◽  
Vol 285 (6) ◽  
pp. H2492-H2499 ◽  
Author(s):  
Aleksandr Rovner ◽  
Rebecca Smith ◽  
Neil L. Greenberg ◽  
E. Murat Tuzcu ◽  
Nicholas Smedira ◽  
...  
Keyword(s):  
Left Atrial ◽  
Atrial Pressure ◽  
Left Atrial Pressure ◽  
Intraventricular Pressure ◽  
Pressure Gradients ◽  
Venous Flow ◽  
Suction Force ◽  
Before And After ◽  
Intraventricular Pressure Gradients ◽  
Surgical Myectomy

We sought to validate measurement of intraventricular pressure gradients (IVPG) and analyze their change in patients with hypertrophic obstructive cardiomyopathy (HOCM) after ethanol septal reduction (ESR). Quantitative analysis of color M-mode Doppler (CMM) images may be used to estimate diastolic IVPG noninvasively. Noninvasive IVPG measurement was validated in 10 patients undergoing surgical myectomy. Echocardiograms were then analyzed in 19 patients at baseline and after ESR. Pulsed Doppler data through the mitral valve and pulmonary venous flow were obtained. CMM was used to obtain the flow propagation velocity ( Vp) and to calculate IVPG off-line. Left atrial pressure was estimated with the use of previously validated Doppler equations. Data were compared before and after ESR. CMM-derived IVPG correlated well with invasive measurements obtained before and after surgical myectomy [ r = 0.8, P < 0.01, Δ(CMM – invasive IVPG) = 0.09 ± 0.45 mmHg]. ESR resulted in a decrease of resting LVOT systolic gradient from 62 ± 10 to 29 ± 5 mmHg ( P < 0.001). There was a significant increase in the Vp and IVPG (from 48 ± 5to 74 ± 7 cm/s and from 1.5 ± 0.2 to 2.6 ± 0.3 mmHg, respectively, P < 0.001 for both). Estimated left atrial pressure decreased from 16.2 ± 1.1 to 11.5 ± 0.9 mmHg ( P < 0.001). The increase in IVPG correlated with the reduction in the LVOT gradient ( r = 0.6, P < 0.01). Reduction of LVOT obstruction after ESR is associated with an improvement in diastolic suction force. Noninvasive measurements of IVPG may be used as an indicator of diastolic function improvement in HOCM.

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