Venous return disturbances in chronic pulmonary disease: a study using pulsed Doppler echocardiography]

Pulsed Doppler echocardiography was used for investigation of respiratory changes of superior vena caval flow in chronic pulmonary disease to analyze the mode of venous return and its regulating factors. The subjects consisted of 55 patients with various pulmonary diseases and 44 healthy controls. 1. In the controls, the velocities of the S and D waves increased during the inspiratory phase. 2. Patients with pulmonary diseases were categorized into 2 groups. One with the mode of the healthy subjects (normal pattern), and the other with disappearance of the D wave or both the S and D waves (abnormal pattern) in the expiratory phase. All patients with restricted ventilation exhibited the normal patterns, while the abnormal patterns were observed in some of the patients with obstructive ventilation, and most of the patients with combined ventilation. 3. The respiratory patterns of the pressure gradients between the right atrium and subclavian vein reflected patterns of the superior vena caval flow well. In cases with abnormal patterns, the right atrial pressure exceeded the subclavian vein pressure in the expiratory phase. 4. The velocity of the A wave at the expiratory phase correlated significantly with pulmonary vascular resistance and with the mean pulmonary artery pressure. In conclusion, the mode of venous return in patients with pulmonary disease varies depending on the mode of the ventilation disturbance and the presence of right ventricular pressure overload, which is most likely caused by the intrathoracic pressure and by right ventricular filling abnormalities.