Abnormal Doppler pulmonary venous flow patterns in children after repaired total anomalous pulmonary venous connection

Abstract

Doppler echocardiography was used to evaluate pulmonary venous flow patterns in 16 children with repaired total anomalous pulmonary venous connection and in 16 age-matched normal controls. Using right upper pulmonary venous pulsed Doppler tracings, peak velocities and velocity time integrals were determined for ventricular systole, ventricular diastole, and atrial systole. Mitral inflow indexes and cardiac outputs were obtained. Patients with repaired total anomalous pulmonary venous connection and controls were similar in weight, heart rate, mitral inflow indexes, and cardiac output. In normal children, peak velocities were greater during ventricular diastole than systole, but velocity time integrals were greater during ventricular systole than diastole. Compared with normals, repaired patients had unobstructed flow patterns with increased peak velocities during ventricular diastole (0.92 ± 0.35 vs 0.62 ±0.12 m/s) and atrial systole (0.27 ± 0.12 vs 0.17 ±0.04 m/s). Velocity time integrals of repaired patients were increased during atrial systole (0.02 ± 0.01 vs 0.01 ± 0.03 m) but decreased during ventricular systole (0.08 ± 0.03 vs 0.12 ± 0.03 m). Systolic-to-diastolic ratios were decreased in repaired patients for peak velocity (0.56 ± 0.20 vs 0.79 ± 0.12) and velocity time integral (0.6 ± 0.18 vs 1.48 ± 0.35). Thus, pulmonary venous flow in normal children is greater during ventricular systole than during ventricular diastole. Repaired patients show a shift in forward flow from ventricular systole to diastole, with greater reversed flow during atrial systole.