Transesophageal Doppler Echocardiography Study of Pulmonary Venous Flow Pattern in Severe Mitral Stenosis and the Changes Following Balloon Mitral Valvuloplasty

The studies of pulmonary venous flow-pattern in mitral stenosis (MS) have given conflicting data about the type of abnormality. This study was undertaken to assess the pulmonary venous flow-pattern in severe MS and to study the changes occurring after balloon mitral valvuloplasty (BMV). There were 51 patients of MS with sinus rhythm with the mean age of 32.5 ± 9.35 years, 18 males and 33 females. Transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) were performed before and after BMV. Pulmonary venous flow was recorded by TEE from left upper pulmonary vein (PV). Peak velocities (V) and velocity time integrals (VTI) of systolic wave (S), diastolic wave (D), and atrial reversal wave (A) were measured. The Sv/Dv and SVTIIDVTI were calculated. Mitral valve area (MVA) increased from 0.81 ± 0.18 cm2 to 2.02 ± 0.46 cm2, left atrium (LA) mean decreased from 28.55 ± 6.68 mmHg to 13.88 ± 4.89 mmHg, and cardiac output increased from 3.1 ± 0.86 L/min to 3.7 ± 1.02 L/min. The S, D, and A velocities increased from 33.84 ± 13.55 cm/s, 37.24 ± 11.55 cm/s, and 20.53 ±6.7 cm/s to 59.86 ± 18.25 cm/s, 48.43 ± 12.55 cmls, and 24.94 ± 9.14 cmls, respectively. The VTIs ofS, D, and A waves increased from 4.88 ± 2.24 cm, 6 ± 2.45 cm, and 2 ± 0.88 cm to 10.46 ± 4.23 cm, 8.82 ± 3.61 cm, and 2.34 ± 1.29 cm, respectively. MS leads to reduction in pulmonary flow velocities during all the phases. Successful BMV resulted in improvement of all these velocities, with improvement in systolic fraction being the maximum. These improved flows after BMV appear to be secondary to reduction in LA pressure and improved cardiac output.