New pulmonary vein Doppler echocardiographic index predicts significant interatrial shunting in secundum atrial septal defect

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• 作者：Yat-Yin Lam ; Fang Fang ; Gabriel Wai-Kwok Yip ; Zhi-An Li ; Ya Yang ; Cheuk-Man Yu
• 关键词：ASD ; atrial septal defect ; CAW ; continuous antegrade wave ; IAS ; interatrial shunting ; PVar ; pulmonary vein atrial reversal velocity ; PVd ; pulmonary vein diastolic velocity ; PVs ; pulmonary vein systolic velocity ; PV-VTI ; pulmonary vein velocity&ndash ; time
• 刊名：International Journal of Cardiology
• 出版年：2012
• 出版时间：20 September, 2012
• 年：2012
• 卷：160
• 期：1
• 页码：59-65
• 全文大小：808 K

文摘

Background

The relation between pulmonary venous flow (PVF) pattern and degree of left-to-right interatrial shunting (IAS) in patients with secundum atrial septal defect (ASD) is unknown.

Methods

Fifty consecutive ASD patients (14 males, 36 ¡À 17 years) received transthoracic echocardiography (TTE) before and 1 day after transcatheter closure and their results were compared to 40 controls. The ratio of pulmonary-to-systemic flows (Qp/Qs) was assessed by TTE and invasive oximetry.

Results

Pre-closure PV systolic (PVs), diastolic (PVd) velocities and velocity-time integral (PV-VTI) increased, time from onset of ECG Q-wave to the peak PV diastolic wave (Q-PVd) shortened and atrial reversal (PVar) velocity significantly decreased as compared to normals. These findings normalized after closure. Patients with large IAS (defined as invasive Qp/Qs ¡Ý 2) had higher PVs, PVd and PV-VTI, shorter Q-PVd but lower PVar (all p < 0.01) than those with small IAS. Invasive Qp/Qs ratios correlated with PVs, PVd, PV-VTI, Q-PVd and TTE-derived Qp/Qs ratios, ASD sizes and RV end-diastolic dimensions (all p < 0.05). PV-VTI (¦Â = 0.49) and ASD size (¦Â = 0.48) remained independent predictors of large IAS after multivariate analysis. The corresponding sensitivity, specificity and AUC were 89 % , 82 % and 0.90 respectively for a PV-VTI of 30 cm (p < 0.001).

Conclusion

ASD patients with significant IAS have distinguishable PVF features. Doppler evaluation of PV-VTI is a novel additional tool for assessing the magnitude of shunting in these patients non-invasively.