Role of Transthoracic Doppler Pulmonary Venous Flow Pattern in Large Atrial Septal Defects

Abstract

Large uncomplicated atrial septal defect (ASD) alters the pulmonary venous flow (PVF) pattern. We aimed to study the role of transthoracic echocardiography (TTE) in estimating the PVF Doppler abnormalities in ASD. By repeating the study soon after ASD closure, we correlated the hemodynamics of atrial shunting with PVF patterns. This study was performed in a tertiary care referral teaching hospital in 2003. The TTE PVF patterns of 34 patients with ASD were studied. TTE study was reported by two blinded investigators independently. Surgical closure of ASD was done on eleven patients and the early postoperative PVF Doppler pattern was also studied with TTE. PVF patterns were adequately recorded in 34 of 38 (90%) subjects with ASD with equal male: female ratio (n = 17 each). The mean age of the study group was 21.4 +/- 8.7 years. ASD ranged from 10 to 38 mm in diameter with a mean of 18 +/- 4.2 mm. Continuous antegrade wave (CAW, mean 68.45 +/- 13.6 cm/s) replaced normally occurring S and D waves in all ASD patients. The atrial reversal wave was reduced or absent (mean 20.18 +/- 3.28 cm/sec). After ASD closure, the CAW was replaced by the S (46.18 +/- 7.5 cm/sec) and D waves (57.72 +/- 9.7 cm/sec) with increase in atrial reversal wave to 27.81 +/- 5.1 cm/sec. The S and D antegrade waves normally seen in PVF are replaced by a continuous antegrade wave in ASD. Atrial reversal wave is also reduced. PVF waveform becomes normal after ASD closure. TTE PVF Doppler pattern can help estimate ASD hemodynamics.