Author + information
- Received April 7, 1994
- Revision received August 3, 1994
- Accepted August 11, 1994
- Published online January 1, 1995.
- Dag E Teien, MD, PhD∗∗,
- Michael Jones, MD∗,
- Takahiro Shiota, MD, PhD∗∗,
- Izumi Yamada, MD, PhD∗ and
- David J Sahn, MD, FACC∗∗∗
- ↵∗Address for correspondence: Dr. David J. Sahn, Oregon Health Sciences University, Clinical Care Center for Congenital Heart Disease, Doernbecher Memorial Hospital for Children, UHN60, 3181 S.W. Sam Jackson Park Road, Portland, Oregon 97201-3098.
Objectives. This study examined the influence of regurgitant volume on pulmonary venous blood flow patterns in an animal model with quantifiable mitral regurgitation.
Background. Systolic pulmonary venous blood flow is influenced by atrial filling and compliance and ventricular output and by the presence of mitral regurgitation. The quantitative severity of the regurgitant volume itself is difficult to judge in clinical examinations.
Methods. Six sheep with chronic mitral regurgitation produced by previous operation to create chordal damage were examined. At reoperation the heart was exposed and epicardial echocardiography performed. Pulmonary venous blood flow waveforms were recorded by pulsed Doppler under color flow Doppler guidance using a Vingmed 750 scanner. The pulmonary venous systolic inflow to the left atrium was expressed as a fraction of the total inflow velocity time integral. Flows across the aortic and mitral valves were recorded by electromagnetic flowmeters balanced against each other. Pressures in the left ventricle and left atrium were measured directly with high fidelity manometer-tipped catheters. Preload and afterload were systematically manipulated, resulting in 24 stable hemodynamic states.
Results. Simple logarithmic correlation between the regurgitant volume and size of a positive or negative pulmonary venous inflow velocity time integral during systole was good (r = −0.841). By stepwise linear regression analysis with pulmonary venous negative systolic velocity time integral as a dependent variable compared with the regurgitant volume, fractional shortening, left atrial νwave size, systemic vascular resistance and left ventricular systolic pressure, only contributions from νwave size and regurgitant volume (r = 0.80) reached statistical significance in determining pulmonary venous negative systolic flow.
Conclusions. Evaluation of systolic pulmonary venous blood flow velocity time integral can give valuable information helpful for estimating the regurgitant volume secondary to mitral regurgitation.
☆ This study was supported in part by Grant HL 43287 from the National Heart, Lung, and Blood Institute, National Institutes of Health. Dr. Teien was supported by the Swedish Society of Medicine, Stockholm, Sweden, for the period during which this work was performed.
- Received April 7, 1994.
- Revision received August 3, 1994.
- Accepted August 11, 1994.