Bartzokis T, Lee R, Yeoh T K, Grogin H, Schnittger I
Division of Cardiovascular Medicine, Stanford University Medical Center, CA 94305.
J Am Soc Echocardiogr. 1991 Sep-Oct;4(5):457-64. doi: 10.1016/s0894-7317(14)80379-9.
Fifty-eight of 61 consecutive patients undergoing transesophageal echo-Doppler echocardiography provided excellent signals to permit assessment of pulmonary venous blood low patterns. Normal antegrade pulmonary venous flow during ventricular systole was biphasic and was characterized by a short, low velocity (28 +/- 17 cm/sec), early systolic jet (P1), and longer, higher velocity (41 +/- 23 cm/sec), late systolic jet (P2). Antegrade pulmonary venous flow during ventricular diastole (P3) was of moderate velocity (34 +/- 17 cm/sec) and was monophasic; during atrial contraction there was transient, low velocity (-17 +/- 11 cm/sec) and reversal of flow (P4). The early systolic antegrade venous flow (P1) was absent or reversed in rhythm disorders, which interrupted normal synchronized atrioventricular activation. These rhythm disorders also were associated with diminished peak flow velocities during late systole (P2). Abnormalities in systolic left ventricular function and mitral regurgitation also had this effect. Diastolic flow velocities (P3) remained constant, except in patients with mitral regurgitation. In these patients diastolic peak flows were significantly increased above normal. In cases of atrial fibrillation or ventricular pacing the late diastolic reversal of flow resulting from atrial contraction (P4) was absent.
Transesophageal echo-Doppler echocardiography gives high quality signals of pulmonary venous inflow to help assess function of the left ventricle and left atrium. Multiple factors affect the patterns. This study suggests caution in the interpretation of abnormal patterns, particularly of reduced systolic pulmonary vein flow in the presence of left ventricular dysfunction, atrial fibrillation, ventricular pacing, and mitral regurgitation.
61例连续接受经食管超声多普勒心动图检查的患者中，58例获得了极佳信号，从而能够评估肺静脉血流模式。心室收缩期正常的肺静脉前向血流呈双相，其特征为一个短的、低速（28±17厘米/秒）的收缩早期血流峰（P1）和一个较长的、高速（41±23厘米/秒）的收缩晚期血流峰（P2）。心室舒张期的肺静脉前向血流（P3）速度适中（34±17厘米/秒），呈单相；心房收缩期有短暂的低速（-17±11厘米/秒）血流且血流方向逆转（P4）。节律紊乱时收缩早期前向静脉血流（P1）缺失或逆转，这打断了正常的同步房室激活。这些节律紊乱还与收缩晚期血流峰速度（P2）降低有关。左心室收缩功能异常和二尖瓣反流也有这种影响。舒张期血流速度（P3）保持恒定，但二尖瓣反流患者除外。在这些患者中，舒张期血流峰明显高于正常水平。在房颤或心室起搏的情况下，由心房收缩导致的舒张晚期血流逆转（P4）缺失。
经食管超声多普勒心动图可提供高质量的肺静脉血流信号，有助于评估左心室和左心房功能。多种因素影响血流模式。本研究提示，在解释异常模式时应谨慎，尤其是在存在左心室功能障碍、房颤、心室起搏和二尖瓣反流时收缩期肺静脉血流减少的情况。
