INFLUENCE OF JET DIRECTION ON PULMONARY VEIN FLOW PATTERNS SEVERE MITRAL REGURGITATION

Pulmonary vein flow patterns measured with trans esophageal echocardio graphy have been used recently to assess the severity of mitral valve regurgitation. This study was designed to determine whether regurgitan t jet direction selectively influences the pattern of flow in right an d left pulmonary veins. Thirty-seven patients undergoing mitral valve repair or replacement for severe valvular regurgitation were studied i ntraoperatively with biplane transesophageal echocardiography. Regurgi tant jets were classified by color flow mapping as central or wall, wi th the latter further classified as septal, lateral, anterior, or post erior in the two orthogonal scan planes. Pulmonary vein flow patterns were measured with pulsed wave Doppler ultrasonography and categorized as showing normal, blunted, or reversed systolic flow. Right and left pulmonary vein flow patterns were identical in the majority of patien ts studied (78%). Eight patients had discordant flow pat terns. In sev en of eight patients, the more abnormal pattern was seen in the right pulmonary vein, despite the fact that the regurgitant jets were direct ed centrally in four of these seven patients. Since discordant pulmona ry vein flow patterns occurred in 5 of 15 patients (33%) with central jets, but in only 3 of 22 patients (14%) with eccentric wall jets, it is unlikely that mitral regurgitation jet direction per se causes pred ictable and selective unilateral alteration in pulmonary vein flow pat terns.