田辺 一明, 公受　 伸之, 石橋　 豊, 吉富　 裕之, 太田 哲郎, 島田　 俊夫, 盛岡　 茂文, 森山　 勝利

Kazuaki TANABE, Nobuyuki OYAKE, Yutaka ISHIBASHI, Hiroyuki YOSHITOMI, Tetsuro OHTA, Toshio SHIMADA, Shigefumi MORIOKA, Katsutoshi MORIYAMA

島根医科大学第4内科

The Fourth Department of Internal Medicine, Shimane Medical University

キーワード : Pulmonary venous flow, Postural change, Transesophageal echocardiography

The purpose of this study was to evaluate the influence of supine and lateral positions on pulmonary venous flow velocity pattern in normal subjects using transesophageal echocardiography (TEE). Fourteen normal subjects were studied. We recorded left and right pulmonary venous flow velocities and mitral annular motion on left lateral, supine and right lateral positions. The following variables were measured: peak velocity of flow reversal at atrial contraction (A), early systolic flow (S1), late systolic flow (S2) and diastolic flow (D), time-velocity integral of systolic flow (TVI-S) and diastolic flow (TVI-D), the time interval between the beginning of Q wave on electrocardiogram and the peak S2 (Q-S2), systolic descent of mitral annulus toward the apex.
( 1 ) In the left pulmonary vein, peak S2 and TVI-S increased in the left lateral position compared to the right lateral position without significant changes in peak A, peak S1, peak D and TVI-D. Q-S2 time also increased in the left lateral position compared to the right lateral position.
( 2 ) In contrast, in the right pulmonary vein, peak S2 and TVI-S increased in the right lateral position compared to the left lateral position without significant changes in peak A, peak S1, peak D and TVI-D. Q-S2 time also increased in the right lateral position compared to the left lateral position. There was no significant change in systolic descent of mitral annulus toward the apex.
In conclusion, peak S2 and TVI-S of bilateral pulmonary veins altered significantly from left to right lateral positions in normal subjects. These findings may have important implications for the assessment of pulmonary venous flow pattern in patients with heart disease.