Atriogenic Diastolic Reflux

Abstract

HomeCirculationVol. 127, No. 10Atriogenic Diastolic Reflux Free AccessResearch ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplemental MaterialFree AccessResearch ArticlePDF/EPUBAtriogenic Diastolic Reflux46 Years Later Jawad Chaara, MD, Wilhelm Rutishauser, MD and Philippe Meyer, MD Jawad ChaaraJawad Chaara From the Cardiology Service, University Hospital of Geneva, Geneva, Switzerland. Search for more papers by this author , Wilhelm RutishauserWilhelm Rutishauser From the Cardiology Service, University Hospital of Geneva, Geneva, Switzerland. Search for more papers by this author and Philippe MeyerPhilippe Meyer From the Cardiology Service, University Hospital of Geneva, Geneva, Switzerland. Search for more papers by this author Originally published12 Mar 2013https://doi.org/10.1161/CIRCULATIONAHA.112.154617Circulation. 2013;127:e480–e481A 59-year-old man was admitted for shortness of breath due to complete atrioventricular block. A transthoracic echocardiogram was performed to assess left ventricular ejection fraction before pacemaker implantation. Color Doppler recordings in the apical views revealed 2 small and central diastolic transmitral and transtricuspid reverse flows (Figure, A and online-only Data Supplement Movie I), concurrent with a mild aortic regurgitation (Figure, B and online-only Data Supplement Movie II). These reverse diastolic flows started after a nonconducted P wave and ended after the next P wave as demonstrated by color M-mode and pulsed-wave–Doppler recordings of both transmitral (Figure, D and F) and transtricuspid flows (Figure, C and E).Download figureDownload PowerPointFigure. A, Color Doppler, apical 4-chamber view. B, Color Doppler, apical 5-chamber view. C, Pulsed-wave Doppler, transtricuspid flow. D, Pulsed-wave Doppler, transmitral flow. E, Color M-mode, transtricuspid flow. F, Color M-mode, transmitral flow.Atrioventricular (AV) diastolic regurgitation was first described as atriogenic diastolic reflux in patients with AV block by Rutishauser et al1 in 1966 with the use of thermodilution during cardiac catheterization. This study helped to understand the mechanisms of retrograde AV flow during diastole. When atrial contraction is not followed by synchronized ventricular contraction, the AV pressure gradient reverses during atrial relaxation, resulting in AV diastolic regurgitation in the presence of an incompletely closed AV valve. Effective ventricular contraction is indeed mandatory for complete AV closure. AV diastolic regurgitations are nowadays more easily recognized by echocardiography but they remain a puzzling finding.Beside AV block of any degree, AV diastolic regurgitations can also occur in acute aortic regurgitation and severe heart failure in which high left ventricular filling pressures and a poorly compliant left ventricle are the etiopathogenic factors. Because of a low diastolic ventriculoatrial pressure gradient, AV diastolic regurgitations are generally mild and do not usually have therapeutic implications.DisclosuresNone.FootnotesThe online-only Data Supplement is available with this article at http://circ.ahajournals.org/lookup/suppl/doi:10.1161/CIRCULATIONAHA.112.154617/-/DC1.Correspondence to Philippe Meyer, MD, Cardiology Service, University Hospital of Geneva, Rue Gabrielle Perret-Gentil 4, 1211 Geneva 14, Switzerland. E-mail [email protected]Reference1. Rutishauser W, Wirz P, Gander M, Lüthy E. Atriogenic diastolic reflux in patients with atrioventricular block.Circulation. 1966; 34:807–817.LinkGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Yeh L, Montealegre-Gallegos M and Mahmood F (2016) Unusual Transmitral Blood Flow: When and Why?, Journal of Cardiothoracic and Vascular Anesthesia, 10.1053/j.jvca.2016.02.019, 30:4, (1152-1153), Online publication date: 1-Aug-2016. March 12, 2013Vol 127, Issue 10 Advertisement Article InformationMetrics © 2013 American Heart Association, Inc.https://doi.org/10.1161/CIRCULATIONAHA.112.154617PMID: 23479669 Originally publishedMarch 12, 2013 PDF download Advertisement SubjectsArrhythmiasEchocardiography