Circulation, Vol 81, 1488-1497, Copyright © 1990 by American Heart Association
RA Nishimura, MD Abel, LK Hatle and AJ Tajik
It has previously been demonstrated that predictable changes occur in
mitral flow velocities under different loading conditions. The purpose of
this study was to relate changes in pulmonary venous and mitral flow
velocities during different loading conditions as assessed by
transesophageal echocardiography in the operating room. Nineteen patients
had measurements of hemodynamics, that is, mitral and pulmonary vein flow
velocities during the control situation, a decrease in preload by
administration of nitroglycerin, an increase in preload by administration
of fluids, and an increase in afterload by infusion of phenylephrine. There
was a direct correlation between the changes in the mitral E velocity and
the early peak diastolic velocity in the pulmonary vein curves (r = 0.61)
as well as a direct correlation between the deceleration time of the mitral
and pulmonary venous flow velocities in early diastole (r = 0.84). This
indicates that diastolic flow velocity in the pulmonary vein is determined
by the same factors that influence the mitral flow velocity curves. A
decrease in preload caused a significant reduction in the initial E
velocity and prolongation of deceleration time, and an increase in preload
caused an increase in E velocity and shortening of deceleration time. An
increase in afterload produced a variable effect on the initial E velocity
and deceleration time and was dependent on the left ventricular filling
pressure. The change in systolic forward flow velocity in the pulmonary
vein was directly proportional to the change in cardiac output (r = 0.60).
The pulmonary capillary wedge pressure correlated best with the flow
velocity reversal in the pulmonary vein at atrial contraction (r = 0.81).
Use of pulmonary vein velocities in conjunction with mitral flow velocities
can help in understanding left ventricular filling.
ARTICLES
Relation of pulmonary vein to mitral flow velocities by transesophageal Doppler echocardiography. Effect of different loading conditions
Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905.
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