Pulmonary Vein Flow Pattern in Mitral Incompetence, Combined Mitral Stenosis/Incompetence and After Prosthetic Valve Replacement

Abstract

Pulmonary vein flow (PVF) pattern was studied with an electromagnetic flowmeter in 11 patients with combined mitral stenosis/incompetence (MS/MI), in 6 patients with pure mitral incompetence (MI) and in 24 patients after mitral valve replacement (MVR). ECG, left atrial and left ventricular pressures were recorded simultaneously. The anomalous flow patterns, which were recorded, reflected the left atrial events and mitral valve function. Before MVR, the major forward flow occurred in ventricular diastole. In patients with predominating MS and small/moderate MI, a small retrograde PVF (RF) occurred in early ventricular systole, while pure or combined severe MI produced a holosystolic reversal of PVF. Our recordings indicate that a RF >25% and a delay in forward PVF after the beginning of ventricular systole >0.20 sec indicate severe MI, while a delay <0.10 sec and RF <15% point to MI of small haemodynamic significance. In the majority of patients, good correlation was found between reversed PVF and mitral regurgitation demonstrated at left ventricular cinéangiography, but there were exceptions. The difficulties in interpretating the angiography in ectopic heart beats are pointed out. The different factors which influence the PVF pattern are discussed. After MVR, normalization of the PVF pattern occurred in 4/24 patients. However, RF was reduced to less than 10% in 22 patients, indicating the important role of mitral valve function in the generation of reversed PVF. The method of PVF measurement is simple and provides objective and reliable information about mitral valve function, and is especially suited for evaluation of the degree of mitral regurgitation.

Additional information

Notes on contributors

Erling Skagseth

Joyce Laing works in the Department of Child and Family Psychiatry, Playfield House, Cupar, Fife, and is a Consultant Art Therapist to Psychiatric Hospitals and Prisons and Chairwoman of the Scottish Society of Art and Psychology.