Factors influencing pulmonary venous flow velocity patterns in mitral regurgitation: an in vitro study.

OBJECTIVES: The aim of this study was to investigate factors affecting pulmonary venous flow patterns in mitral regurgitation. BACKGROUND: Although pulmonary venous flow velocity patterns have been reported to be helpful in assessing the severity of mitral regurgitation, the influence of regurgitant jet direction, pulmonary venous location and left atrial pressures on pulmonary venous flow patterns has yet to be clarified. METHODS: The mitral regurgitant jet was produced by a pulsatile piston pump at 10, 30 and 40 ml/beat through a circular orifice, whereas the pulmonary venous flow was driven by gravity. Four different patterns of pulmonary venous flow and mitral regurgitation were examined. The V wave pressure was set at 10, 30 and 50 mm Hg and pulmonary venous flow velocity at 30 cm/s. Color and pulsed Doppler recordings were obtained with a VingMed 800 scanner interfaced with a computer facilitating digital analysis. RESULTS: The decrease in the velocity time integral of pulmonary venous flow was more prominent for any given volume of mitral regurgitation at higher left atrial pressure. When the mitral regurgitant jet was directed toward the pulmonary vein, a more prominent decrease in the velocity time integral was seen, especially for severe mitral regurgitation (40 ml) with high left atrial pressure (95% vs. 55%, p < 0.001); and the time to peak deceleration of forward flow was significantly shorter (485 vs. 523 ms, respectively, p < 0.01). Also, two different types (laminar and turbulent) of reversed pulmonary venous flow were observed. CONCLUSIONS: Multiple factors, including jet direction, mitral regurgitant volume and left atrial pressure, determine the effect of mitral regurgitation on pulmonary venous flow velocity patterns.

Effects of pulmonary venous flow direction on mitral regurgitation jet area as imaged by color Doppler flow mapping. An in vitro study.

BACKGROUND: Although the effects of adjacent walls and left atrial pressure on mitral regurgitation (MR) jet area imaged by color Doppler have been examined, few data exist regarding the influence of pulmonary venous (PV) filling flow on regurgitant jets. Therefore, we designed a left atrial model to examine the relation between PV flow direction and MR jet area. METHODS AND RESULTS: The left atrial chamber (7.6 cm in diameter) was built with a PV inflow (1.0 cm in diameter) and mitral valve regurgitant orifice in the same plane. The MR jet was simulated as fixed in volume and velocity (3.5 m/s) and directed with a pulsatile pump into the left atrial model. PV flow with a constant velocity (30 cm/s) was driven by gravity (83 cm H2O). With left atrial mean pressure at either 10, 30, or 50 mm Hg, four flow patterns were examined: (1) PV flow away from the mitral valve, MR jet toward the pulmonary vein; (2) PV flow toward the mitral valve, MR jet toward the pulmonary vein; (3) PV flow away from the mitral valve, MR jet away from the pulmonary vein; and (4) PV flow toward the mitral valve, MR jet away from the pulmonary vein. MR color Doppler images were recorded with a 3.5-mHz frequency transducer and at 7-kHz pulse repetition frequency. For each condition, we compared jet area, length, and width of the MR signal. MR jet areas for conditions 3 and 4 were larger at 10 mm Hg than at 30 or 50 mm Hg left atrial pressure. Especially at the lower pressures, PV flow diminished the MR jet area in condition 4 compared with that in condition 3, such that MR jets were smaller in condition 4. In conditions 1 and 2, the jets were imaged at an oblique angle and were smaller than in conditions 3 and 4 (P < .001), but they were not significantly different from each other as imaged. CONCLUSIONS: In this model, factors including the direction of PV flow, the direction of MR as relates to the angle of interrogation, and the level of left atrial pressure influenced the size of MR jets. The effect of PV flow direction was diminished by increased left atrial pressure. PV flow directed away from the mitral valve was associated with larger MR jets than when PV flow was directed toward it (condition 4), probably because of jet distortion and flattening.