Pulmonary vein doppler echocardiography after left atrial operation

Background. Intraoperative transesophageal echocardiography provides the surgical team with important guidance during operations for congenital heart disease. Doppler echocardiography adds hemodynamic information to that provided by two-dimensional imaging. Here we describe intraoperative pulmonary vein Doppler echocardiography after operation involving the left atrium. Methods. Intraoperative two-dimensional and pulsed-wave Doppler echocardiography of pulmonary veins were performed after surgical repair of anomalous pulmonary venous return in 4 patients. Results. In 3 patients, intraoperative pulmonary vein Doppler findings were suggestive of obstruction. The surgical repair was thought to be excellent, and there was no obstruction apparent anatomically or clinically. No further intervention was performed, and all patients recovered uneventfully. No pulmonary venous obstruction was noted on follow-up two-dimensional echocardiography, and follow-up pulmonary vein Doppler echocardiography showed the expected pattern. Conclusions. An obstructive pattern in the pulmonary vein Doppler was seen in 3 of 4 patients studied immediately after repair of anomalous pulmonary venous return. No obstruction, however, was manifest then or subsequently. The abnormal Doppler pattern, thus, is not indicative of pulmonary venous obstruction. We propose that acute postoperative changes in left atrial volume and compliance and acute postoperative tissue changes in the left atrium explain the abnormal pulmonary vein Doppler patterns observed.