Abstract
Background:The left atrium functions as a reservoir for blood stored during ventricular systole, a conduit for pulmonary venous flow during ventricular diastole, and as a pump augmenting left ventricular filling during atrial systole. Cardiac angiography and Doppler echocardiography have been used in the assessment of atrial function. These measurements are, however, quite sensitive to ventricular and atrial loading conditions. Instantaneous pressure-volume relations of the left atrium have been described by a time-varying elastance model in the isolated left atrium and intact circulation in animal models. The mitral stenosis can be characterized hemodynamically as increased afterload of the left atrium. Percutaneous mitral balloon valvuloplasty, which results in a dramatic increase in the mitral orifice area in patients with mitral stenosis, is a well-suited clinical model for physiological assessment of the left atrial function in response to acute change of the left atrial afterload. The purpose of this study was 1) to evaluate the feasibility of the left atrial pressurevolume loop using automatic boundary detection method, 2) to obtain the left atrial pressure-volume loop in patients with mitral stenosis and to compare with that of normal controls, and 3) to assess the changes of the left atrial wall tesion and stroke work after percutaneous mitral balloon valvuloplasty in patients with mitral stenosis using the left atrial pressure-volume relations. Methods:Twelve patients had simultaneous measurements of left atrial pressure and left atrial volume using trasseptal catheterization and twodimensional echocardiography with automatic boundary detection technology. The left atrial pressure-volume was constructed by a computer workstation interfaced with an ultrasound system. Left atrial volumetric parameters, areas of A and V loops, and peak wall tension were measured and compared before and after 논문접수일:1998년 2월 6일 심사완료일:1998년 4월 27일 교신저자:하종원, 120-140 서울 서대문구 신촌동 134번 연세대학교 의과대학 심장혈관센터 심장내과학교실 전화:(02) 361-7071·전송:(02) 393-2041 E-mail:jwha@yumc.yonsei.ac.kr
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