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Am J Physiol Heart Circ Physiol 279: H594-H600, 2000;
0363-6135/00 $5.00
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Vol. 279, Issue 2, H594-H600, August 2000

Doppler echo evaluation of pulmonary venous-left atrial pressure gradients: human and numerical model studies

Michael S. Firstenberg1, Neil L. Greenberg1, Nicholas G. Smedira2, David L. Prior1, Gregory M. Scalia1, James D. Thomas1, and Mario J. Garcia1

Departments of 1 Cardiology and 2 Thoracic and Cardiovascular Surgery, Cardiovascular Imaging Center, The Cleveland Clinic Foundation, Cleveland, Ohio 44195

The simplified Bernoulli equation relates fluid convective energy derived from flow velocities to a pressure gradient and is commonly used in clinical echocardiography to determine pressure differences across stenotic orifices. Its application to pulmonary venous flow has not been described in humans. Twelve patients undergoing cardiac surgery had simultaneous high-fidelity pulmonary venous and left atrial pressure measurements and pulmonary venous pulsed Doppler echocardiography performed. Convective gradients for the systolic (S), diastolic (D), and atrial reversal (AR) phases of pulmonary venous flow were determined using the simplified Bernoulli equation and correlated with measured actual pressure differences. A linear relationship was observed between the convective (y) and actual (x) pressure differences for the S (y = 0.23x + 0.0074, r = 0.82) and D (y = 0.22x + 0.092, r = 0.81) waves, but not for the AR wave (y = 0.030x + 0.13, r = 0.10). Numerical modeling resulted in similar slopes for the S (y = 0.200x - 0.127, r = 0.97), D (y = 0.247x - 0.354, r = 0.99), and AR (y = 0.087x - 0.083, r = 0.96) waves. Consistent with numerical modeling, the convective term strongly correlates with but significantly underestimates actual gradient because of large inertial forces.

pulmonary veins; echocardiography; fluid dynamics; numerical modeling


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T. N. Hobson, J. A. Flewitt, I. Belenkie, and J. V. Tyberg
Wave intensity analysis of left atrial mechanics and energetics in anesthetized dogs
Am J Physiol Heart Circ Physiol, March 1, 2007; 292(3): H1533 - H1540.
[Abstract] [Full Text] [PDF]




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