Individual pulmonary vein imaging by transthoracic echocardiography: an inadequate traditional interpretation

There existed an ambiguity in the current echo literature about the identification of the pulmonary veins imaged by echocardiography. This study was designed to identify the site and blood flow of individual pulmonary veins by transthoracic echocardiography.

Transthoracic echocardiography was used to display individual pulmonary veins in the apical and parasternal short-axis views in 20 adult patients with atrial septal defect. Cardiac catheterization, selective angiography, and contrast echocardiography were used to identify and validate the exact site of individual pulmonary veins. The right lower and upper veins were best seen in the apical four-chamber and the near apical five-chamber views, respectively. Both left pulmonary veins were best displayed in the parasternal short-axis view. When all the individual pulmonary veins were seen simultaneously in the apical views, from left to right of the sector, they were the right upper, right lower, left lower, and left upper pulmonary veins, respectively.

This prospective study provides a feasible method to prove that transthoracic echocardiography can visualize clearly and identify accurately the exact site of each pulmonary vein. The information should be helpful to study various pulmonary venous diseases.