Abstract
The noninvasive assessment of mitral regurgitation has been an elusive clinical goal. Recent studies have highlighted the value of pulmonary venous (PV) flow reversal in indicating the presence of severe regurgitation. The purpose of this study was to explore the basic determinants of PV inflow in the presence and absence of regurgitation. In particular, the hypothesis that systolic PV flow depends on the interaction of regurgitant volume with atrial and PV properties (compliance, initial volume, total area of the pulmonary veins at the atrial junction, and the inertia of PV inflow) was tested and further, that the combination of these variables, rather than regurgitant volume alone, determines PV inflow. A mathematical model of the atrium and pulmonary veins was developed. Atrial and PV pressure were modeled as the product of chamber elastance and volume, where atrial elastance varied in time to simulate atrial relaxation and descent of the mitral anulus. A simplification of the modified unsteady Bernoulli equation was used to compute the PV velocities that resulted from the developed pressure gradient. The modeling was performed over a range of initial atrial elastances (0.77 to 0.2 mm Hg/cc), initial atrial volumes (20 to 75...Continue Reading
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