Unilateral pulmonary artery branch stenosis: Diastolic prolongation of forward flow appears to maintain flow to the affected lung if the pulmonary valve.

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Unilateral pulmonary artery branch stenosis: Diastolic prolongation of forward flow appears to maintain flow to the affected lung if the pulmonary valve is competent Sylvia SM Chen, Philip J Kilner International Journal of Cardiology Volume 168, Issue 4, Pages 3698-3703 (October 2013) DOI: 10.1016/j.ijcard.2013.06.019 Copyright © 2013 Terms and Conditions

Fig. 1 Still image of the pulmonary artery at its bifurcation and its branches and corresponding flow curves in (A) a patient after the arterial switch repair for transposition of the great arteries (TGA-ASO) with a near competent pulmonary valve and right pulmonary artery (RPA) stenosis, and in (B) a patient after repair of tetralogy of Fallot (rToF) with an incompetent pulmonary valve and left pulmonary artery (LPA) stenosis. International Journal of Cardiology 2013 168, 3698-3703DOI: (10.1016/j.ijcard.2013.06.019) Copyright © 2013 Terms and Conditions

Fig. 2 Averaged branch pulmonary artery flow curves of (A) controls, (B) patients with near competent pulmonary valve and (C) patients with incompetent pulmonary valve. In both patient groups, systolic flow through the stenosed artery was lower than in normal controls. There was a diastolic prolongation of forward flow in the stenosed relative to non-stenosed branch in those with near competent pulmonary valves, but not in those with incompetent pulmonary valves. There was regurgitant flow from the non-stenosed branch, indicated by negative flow in diastole of patients with near competent pulmonary valves, and from both stenosed and non-stenosed branches of patients with incompetent pulmonary valves. In normal controls, peak flow was equal in both branch arteries. Neither significant regurgitation nor a diastolic tail was seen in normal controls. RPA: right pulmonary artery; LPA: left pulmonary artery. International Journal of Cardiology 2013 168, 3698-3703DOI: (10.1016/j.ijcard.2013.06.019) Copyright © 2013 Terms and Conditions

Fig. 3 Comparison of diameter (A) and flow (B) of the pulmonary arteries between stenosed and non-stenosed branch arteries in patients with near competent pulmonary valves and in those with incompetent pulmonary valves. In both patient groups, the diameter of the stenosed artery was much smaller than the non-stenosed artery. Flow was comparable in the near competent pulmonary valve group, but was much less in the stenosed artery relative to the non-stenosed artery of the incompetent pulmonary valve group. PV: pulmonary valve. International Journal of Cardiology 2013 168, 3698-3703DOI: (10.1016/j.ijcard.2013.06.019) Copyright © 2013 Terms and Conditions

Fig. 4 Averaged branch pulmonary artery flow curves for the (A) right pulmonary (RPA) and (B) left pulmonary (LPA) artery stenosis in both the near competent and incompetent pulmonary valve groups. The diastolic prolongation of forward flow was seen in both RPA and LPA stenosis in the near competent pulmonary valve group. There was slight diastolic prolongation in RPA stenosis in the incompetent pulmonary valve group, followed by regurgitation in mid diastole. No diastolic forward flow prolongation was seen in those with incompetent pulmonary valves and LPA stenosis. In both RPA and LPA stenosis and incompetent pulmonary valves, there is late diastolic forward flow. International Journal of Cardiology 2013 168, 3698-3703DOI: (10.1016/j.ijcard.2013.06.019) Copyright © 2013 Terms and Conditions