Hwang J J, Lin J M, Hsu K L, Lai L P, Tseng Y Z, Lee Y T, Lien W P
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, ROC.
Cardiology. 1999;91(4):256-63. doi: 10.1159/000006920.
To evaluate the correlation of the flow patterns of the four pulmonary veins as assessed by transesophageal echocardiography and the influence of significant mitral regurgitation on this correlation.
Eighty-eight patients with normal sinus rhythm and variable underlying cardiovascular diseases underwent transthoracic and transesophageal echocardiographic studies. Doppler flow of the four pulmonary veins could not be adequately interpreted in 19 patients (22%). The left atrial dimension of these patients was significantly larger than that of the patients with complete study of the flow in the four pulmonary veins (49 +/- 6 vs. 43 +/- 7 mm; p < 0.05). Of the 69 patients with complete evaluation of the four pulmonary veins, 48 patients without significant mitral regurgitation were analyzed as group A, and the remaining 21 patients as group B. The peak systolic and diastolic forward flow velocities of the four pulmonary veins were measured and the ratio of peak systolic (S) to diastolic (D) flow velocity was calculated. Group A had a significantly larger S/D ratio in all four pulmonary veins than group B (p < 0.05 in each pulmonary vein measurement). There was good correlation of the flow pattern represented as S/D ratio between left upper and lower pulmonary veins (r = 0.90) and between right upper and lower pulmonary veins (r = 0.89) in group A. The correlation of the flow pattern among the four pulmonary veins deteriorated in group B.
Pulmonary veins on the same side share rather similar flow patterns in comparison with pulmonary veins on the opposite sides. The correlation of flow patterns among the four pulmonary veins is good in subjects without significant mitral regurgitation, but it worsens in patients with significant mitral regurgitation. Therefore, cautious interpretation of flow patterns of the four pulmonary veins in patients with significant regurgitation is indicated for grading the severity of mitral regurgitation.
评估经食管超声心动图所评估的四条肺静脉血流模式的相关性，以及严重二尖瓣反流对这种相关性的影响。
88例窦性心律正常且患有不同基础心血管疾病的患者接受了经胸和经食管超声心动图检查。19例患者（22%）的四条肺静脉的多普勒血流无法得到充分解读。这些患者的左心房内径显著大于四条肺静脉血流研究完整的患者（49±6 vs. 43±7 mm；p<0.05）。在69例四条肺静脉评估完整的患者中，48例无严重二尖瓣反流的患者被分析为A组，其余21例患者为B组。测量四条肺静脉的收缩期和舒张期正向血流峰值速度，并计算收缩期峰值（S）与舒张期（D）血流速度之比。A组所有四条肺静脉的S/D比值均显著大于B组（每条肺静脉测量中p<0.05）。在A组中，左上和左下肺静脉之间以及右上和右下肺静脉之间以S/D比值表示的血流模式具有良好的相关性（r=0.90）和（r=0.89）。B组中四条肺静脉之间的血流模式相关性变差。
与对侧肺静脉相比，同侧肺静脉的血流模式相当相似。在无严重二尖瓣反流的受试者中，四条肺静脉之间的血流模式相关性良好，但在严重二尖瓣反流患者中则变差。因此，对于严重反流患者，在评估二尖瓣反流严重程度时，对四条肺静脉血流模式的解读需谨慎。
