Doppler echo evaluation of pulmonary venous-left atrial pressure gradients: Human and numerical model studies

Michael S. Firstenberg, Neil L. Greenberg, Nicholas G. Smedira, David L. Prior, Gregory M. Scalia, James D. Thomas, And Mario J Garcia

Research output: Contribution to journalArticlepeer-review

18 Scopus citations

Abstract

The simplified Bernoulli equation relates fluid convective energy derived from flow velocities to a pressure gradient and is commonly used in clinical echocardiography to determine pressure differences across stenotic orifices. Its application to pulmonary venous flow has not been described in humans. Twelve patients undergoing cardiac surgery had simultaneous high-fidelity pulmonary venous and left atrial pressure measurements and pulmonary venous pulsed Doppler echocardiography performed. Convective gradients for the systolic (S), diastolic (D), and atrial reversal (AR) phases of pulmonary venous flow were determined using the simplified Bernoulli equation and correlated with measured actual pressure differences. A linear relationship was observed between the convective (y) and actual (x) pressure differences for the S (y = 0.23x + 0.0074, r = 0.82) and D (y = 0.22x + 0.092, r = 0.81) waves, but not for the AR wave (y = 0.030x + 0.13, r = 0.10). Numerical modeling resulted in similar slopes for the S (y = 0.200x - 0.127, r = 0.97), D (y = 0.247x - 0.354, r = 0.99), and AR (y = 0.087x - 0.083, r = 0.96) waves. Consistent with numerical modeling, the convective term strongly correlates with but significantly underestimates actual gradient because of large inertial forces.

Original languageEnglish (US)
Pages (from-to)H594-H600
JournalAmerican Journal of Physiology - Heart and Circulatory Physiology
Volume279
Issue number2 48-2
DOIs
StatePublished - 2000

Keywords

  • Echocardiography
  • Fluid dynamics
  • Numerical modeling
  • Pulmonary veins

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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