Echo: Normal Pulmonary (&Systemic) Vein Doppler pattern

Normal Doppler Pattern in Pulmonary (& Systemic) Vein:
(Extract from JASE 2010;23:465-95; Pulmonary Vein PW Doppler)

Provides evaluation of Ventricular Diastolic Function and AV valve Function.
S wave: (Antergrade flow during Ventricular Systole)
Antegrade flow occurs because of both Atrial relaxation and Apical movement of AVV;
Biphasic if there is temporal dissociation of atrial relaxation and apical movement of AVV.
Abnormal retrograde flow occurs with AVV regurgitation & Atrial contraction against closed AVV.

D wave: (Antegrade flow during Ventricular Diastole)
Antegrade flow occurs because of Atrial and Ventricular filling & AVV patency.
Fast HR - leads to fusion of S and D peaks.
Ar wave: (Retrograde flow during Atrial systole)
Augmented when ventricular compliance is poor.
Ar wave duration exceeds MV inflow duration when LAP & LVEDP are elevated.
Respiratory variation:
During inspiration - D wave velocity increases. Ar wave velocity decreases.
So, measurements should be made over 3 consecutive cycles.

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