The potential value of transoesophageal evaluation of individual pulmonary venous flow after an atrial baffle procedure

Abstract

Following a Mustard's procedure, transoesophageal echocardiography allowed the visualization of all 4 pulmonary veins in 7 12 patients (mean age 14.8 years) and of three veins in a further 2 patients. Both upper pulmonary veins could be visualized consistently. No patient had an isolated pulmonary venous stenosis. In 9 pateints in sinus rhythm, computer analysis of Doppler tracings from the left upper pulmonary vein showed significantly lower systolic peak velocities (mean 0.39 ± 0.10 m/s) and time velocity integrals (mean 6.9 ± 1.66 cm) than in normal subjects (mean 0.6 ± 0.09 m/s and 14.4 ± 2.97 cm respectively; P < 0.001). We postulate that this is due to compromised atrial relaxation and compliance. In contrast, diastolic time velocity integrals were normal in 9 patients in sinus rhythm, but invariably elevated in 3 patients in junctional rhythm (mean 10.7 vs 7.7 cm in normal subjects). Flow reversal during early ventricular systole (due to tricuspid regurgitation or atrial contraction after retrograde conduction during junctional rhythm) was detected in 6 12 patients. These results confirm that the transoesophageal approach should allow the identification of isolated pulmonary venous obstruction after a Mustard procedure. In addition, detailed analysis of tracings of flow in the pulmonary veins can document the presence of compromised atrial relaxation and help to evaluate the severity of tricuspid regurgitation. It may provide a new index with which to assess impaired systemic ventricular function.