西尾 秀樹, 松崎 益徳, 友近 康明, 和崎 雄一郎, 藤野 尚子, 高木 昭, 楠川 禮造

Hideki NISHIO, Masunori MATSUZAKI, Yasuaki TOMOCHIKA, Yuichiro WASAKI, Hisako FUJINO, Akira TAKAGI, Reizo KUSUKAWA

山口大学医学部第二内科

The Second Department of Internal Medicine, Yamaguchi University School of Medicine

キーワード : Pulmanary venous return, Transesophageal Doppler echocardiography, Positional change

We examined the profiles of right and left pulmonary venous flow (PVF) patterns and the influence of the body positional change on each wave using transesophageal Doppler echocardiography (TEE). Forty-six patients consisting of 13 normal subjects, 16 with coronary artery disease, 6 with aortic aneurysm, 5 with hypertension and 6 with hypertrophic cardiomyopathy were studied. All patients were sinus rhythm, and patients with mitral valvular disease were excluded from the study. We recorded left and right PVF using TEE on supine position, and then on left lateral position. PVF consisted of a reverse flow at the atrial contraction (A wave) followed by systolic forward flows (S1, S2 wave) and diastolic forward flow (D wave). The following variables were measured: peak flow velocity of each wave (pA, pS1, pS2, pD), time-velocity integral of each wave (IA, IS1, IS2, ID) , the time intervals from P wave on ECG to A wave (P-A), from P wave to S1 wave (P-S1), from Q wave on ECG to S2 wave (Q-S2), from the second heart sound on PCG to D wave (II a-D) and dimensions of both pulmonary veins at the phase of atrial contraction.
The time intervals of P-A (pOn the other hand, in the right PVF, a fusion of S1 and S2 waves were found in 81% of all subjects by changing the posture to the left lateral position, and also pA (pThus, we concluded that (1) on supine position bilateral PVF showed similar patterns, however, the timing of each wave in the right pulmonary vein occured later than those in the left pulmonary vein, which may be attributed to the morphological relation between both veins, (2) by changing the posture to the left lateral, right PVF pattern was significantly altered, which may be caused by the change in pulmonary blood flow distribution between right and left lungs, resulting from the elevation of hydrostatic pressure in the right lung.