Klein A L, Stewart W J, Bartlett J, Cohen G I, Kahan F, Pearce G, Husbands K, Bailey A S, Salcedo E E, Cosgrove D M
Department of Cardiology, Cleveland Clinic Foundation, Ohio 44195-5064.
J Am Coll Cardiol. 1992 Nov 15;20(6):1345-52. doi: 10.1016/0735-1097(92)90247-k.
Pulmonary venous flows recorded by pulsed wave Doppler transesophageal echocardiography examination can be used to assess the severity of mitral regurgitation. Pulmonary venous flows are also related to left atrial pressures; however, the determinants of these flows have yet to be characterized in the presence of mitral regurgitation.
We simultaneously recorded intraoperative pulmonary venous flows by transesophageal echocardiography and left atrial pressures by direct left atrial puncture in 16 patients with different grades of mitral regurgitation: 2+ (n = 5), 3+ (n = 4) and 4+ (n = 7). Pulmonary venous peak systolic and diastolic flow velocities and peak reversed systolic flow velocities were compared with left atrial pressure a and v waves, a-x and v-y descent values and left atrial volumes.
Pulmonary venous systolic to diastolic flow ratios correlated with decreases in left atrial pressure a/v ratios and with increases in the v waves of patients with higher grades of mitral regurgitation. Univariate analysis revealed that the best determinants of the pulmonary venous systolic to diastolic flow ratio were the left atrial pressure v wave (r = -0.76), the v-y descent value (r = -0.73) and the a/v ratio (r = 0.71). Lower correlations were found for left atrial end-systolic (r = -0.48) and end-diastolic (r = -0.42) volumes. Reversed systolic flow was present in patients with 4+ mitral regurgitation, despite left atrial enlargement.
Pulmonary venous flow can be used to assess the severity of mitral regurgitation and reflects the effects of mitral regurgitation severity on the left atrial pressure a and v waves.
经食管超声心动图脉冲波多普勒检查记录的肺静脉血流可用于评估二尖瓣反流的严重程度。肺静脉血流也与左心房压力有关；然而，在二尖瓣反流情况下这些血流的决定因素尚未明确。
我们对16例不同程度二尖瓣反流的患者（2+级5例、3+级4例、4+级7例），术中同时经食管超声心动图记录肺静脉血流，并通过直接左心房穿刺记录左心房压力。比较肺静脉收缩期和舒张期峰值流速以及收缩期反向峰值流速与左心房压力a波和v波、a - x和v - y下降值以及左心房容积。
肺静脉收缩期与舒张期血流比值与二尖瓣反流程度较高患者的左心房压力a/v比值降低以及v波升高相关。单因素分析显示，肺静脉收缩期与舒张期血流比值的最佳决定因素是左心房压力v波（r = -0.76）、v - y下降值（r = -0.73）和a/v比值（r = 0.71）。与左心房收缩末期（r = -0.48）和舒张末期（r = -0.42）容积的相关性较低。尽管左心房扩大，但4+级二尖瓣反流患者仍存在收缩期反向血流。
肺静脉血流可用于评估二尖瓣反流的严重程度，并反映二尖瓣反流严重程度对左心房压力a波和v波的影响。
