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Uppu SC, Srivastava S, Love BA. Ventricular septal defect Doppler peak gradient underestimates right ventricular systolic pressure in the presence of right bundle branch block. Ann Pediatr Cardiol 2022; 15:320-322. [PMID: 36589654 PMCID: PMC9802622 DOI: 10.4103/apc.apc_167_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 09/08/2021] [Accepted: 03/19/2022] [Indexed: 11/17/2022] Open
Abstract
Estimation of the right ventricular systolic pressure (RVSP) using echocardiographically derived maximal instantaneous gradient across the ventricular septal defect is a well-utilized tool, which can potentially underestimate the RVSP in patients with conduction abnormalities as such its utility in these patients is questionable.
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Affiliation(s)
- Santosh C. Uppu
- Department of Pediatric Cardiology, Children's Heart Institute, UT Health Houston McGovern Medical School, Houston, TX, USA
| | - Shubhika Srivastava
- Department of Pediatric Cardiology, Nemours Children's Health System, Wilmington, DE, USA
| | - Barry A. Love
- Division of Pediatric Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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2
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Meinel K, Koestenberger M, Sallmon H, Hansmann G, Pieles GE. Echocardiography for the Assessment of Pulmonary Hypertension and Congenital Heart Disease in the Young. Diagnostics (Basel) 2020; 11:diagnostics11010049. [PMID: 33396225 PMCID: PMC7823322 DOI: 10.3390/diagnostics11010049] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 12/21/2020] [Accepted: 12/22/2020] [Indexed: 12/18/2022] Open
Abstract
While invasive assessment of hemodynamics and testing of acute vasoreactivity in the catheterization laboratory is the gold standard for diagnosing pulmonary hypertension (PH) and pulmonary vascular disease (PVD) in children, transthoracic echocardiography (TTE) serves as the initial diagnostic tool. International guidelines suggest several key echocardiographic variables and indices for the screening studies when PH is suspected. However, due to the complex anatomy and special physiological considerations, these may not apply to patients with congenital heart disease (CHD). Misinterpretation of TTE variables can lead to delayed diagnosis and therapy, with fatal consequences, or–on the other hand-unnecessary invasive diagnostic procedures that have relevant risks, especially in the pediatric age group. We herein provide an overview of the echocardiographic workup of children and adolescents with PH with a special focus on children with CHD, such as ventricular/atrial septal defects, tetralogy of Fallot or univentricular physiology. In addition, we address the use of echocardiography as a tool to assess eligibility for exercise and sports, a major determinant of quality of life and outcome in patients with PH associated with CHD.
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Affiliation(s)
- Katharina Meinel
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, 8036 Graz, Austria; (K.M.); (M.K.)
- European Pediatric Pulmonary Vascular Disease Network, 13125 Berlin, Germany; (H.S.); (G.H.)
| | - Martin Koestenberger
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, 8036 Graz, Austria; (K.M.); (M.K.)
- European Pediatric Pulmonary Vascular Disease Network, 13125 Berlin, Germany; (H.S.); (G.H.)
| | - Hannes Sallmon
- European Pediatric Pulmonary Vascular Disease Network, 13125 Berlin, Germany; (H.S.); (G.H.)
- Department of Pediatric Cardiology, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany
- Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum Berlin (DHZB), 13353 Berlin, Germany
| | - Georg Hansmann
- European Pediatric Pulmonary Vascular Disease Network, 13125 Berlin, Germany; (H.S.); (G.H.)
- Department of Pediatric Cardiology and Critical Care, Hannover Medical School, 30625 Hannover, Germany
| | - Guido E. Pieles
- European Pediatric Pulmonary Vascular Disease Network, 13125 Berlin, Germany; (H.S.); (G.H.)
- National Institute for Health Research (NIHR) Cardiovascular Biomedical Research Centre, Congenital Heart Unit, Bristol Royal Hospital for Children and Bristol Heart Institute, Bristol BS2 8HW, UK
- Institute of Sport Exercise and Health (ISEH), University College London, London W1T 7HA, UK
- Correspondence:
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3
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Dimopoulos K, Condliffe R, Tulloh RM, Clift P, Alonso-Gonzalez R, Bedair R, Chung NA, Coghlan G, Fitzsimmons S, Frigiola A, Howard LS, Jenkins P, Kenny D, Li W, MacDonald ST, McCabe C, Oliver JJ, Spence MS, Szantho GV, von Klemperer K, Wilson DG, Wort SJ. Echocardiographic Screening for Pulmonary Hypertension in Congenital Heart Disease. J Am Coll Cardiol 2018; 72:2778-2788. [DOI: 10.1016/j.jacc.2018.08.2201] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 07/26/2018] [Accepted: 08/14/2018] [Indexed: 01/08/2023]
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4
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Hildebrandt N, Leuser C, Miltz D, Henrich E, Schneider M. [Restrictive ventricular septal defect in a dwarf rabbit]. TIERAERZTLICHE PRAXIS AUSGABE KLEINTIERE HEIMTIERE 2016; 44:59-64. [PMID: 26763583 DOI: 10.15654/tpk-150208] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 05/26/2015] [Indexed: 11/13/2022]
Abstract
A 9-week-old intact female dwarf rabbit was presented for evaluation of a heart murmur. Physical examination revealed a grade IV/VI systolic heart murmur with the maximal intensity over the right heart base. Evidence for a left-sided cardiomegaly was present on lateral and dorsoventral radiographs. An electrocardiogram was recorded in right lateral recumbency, which revealed a sinus tachycardia with a heart rate of 360 beats/minute. Echocardiography showed normal dimensions for the atria and ventricles. Two-dimensional echocardiography confirmed the presence of a perimembranous ventricular septal defect (VSD) with a diameter of 0.8 mm. Identification of the VSD was possible from a right (long and short axes) and a left parasternal window. Peak flow velocity of the systolic left to right shunt was 5.2 m/s. Additionally, a relative pulmonic stenosis (peak flow in the pulmonary artery of 1.02 m/s, pulsed-wave Doppler) was present. According to these findings, the VSD was classified as restrictive. At this time point, medical treatment was unnecessary. The re-examination after 7 weeks revealed unchanged morphological and haemodynamic findings. The VSD in this dwarf rabbit displayed both in the physical and echocardiographic examinations typical features as seen in dogs and cats as well as in one New Zealand white rabbit.
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Affiliation(s)
- N Hildebrandt
- Nicolai Hildebrandt, Klinikum Veterinärmedizin, Klinik für Kleintiere (Innere Medizin), Justus-Liebig-Universität Gießen, Frankfurter Straße 126, 35392 Gießen, E-Mail:
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5
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Sorantin E, Heinzl B. What every radiologist should know about paediatric echocardiography. Eur J Radiol 2014; 83:1519-28. [PMID: 24938668 DOI: 10.1016/j.ejrad.2014.05.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 05/14/2014] [Accepted: 05/18/2014] [Indexed: 11/17/2022]
Abstract
Congenital heart defects (CHD) occur in less than one percent of all newborns. Echocardiography represents the imaging modality of choice for morphological and functional assessment. In childhood the different CHD types can be diagnosed trustfully and can be performed bedside. In the follow-up of CHD cross sectional imaging plays an important role and therefore it is essential for the radiologist to know the features, challenges and limitations of echocardiography. Within this review article a systematic approach for morphological and functional assessment of the heart will is given along with representative example images. In addition, typical echocardiographic findings in common CHD is presented. In older children, adolescents and grown-ups with CHD (GUCH) echocardiography suffers from limitations - partially due to skeletal deformations and lung emphysema. In particular right ventricular function assessment is not always possible by echocardiography. Therefore strengths and limitations of echocardiography will be discussed the role of cardiac magnetic resonance imaging (cMRI) and cardiac computed tomography (cCT) emphasized.
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Affiliation(s)
- Erich Sorantin
- Division of Pediatric Radiology, Department of Radiology, Medical University Graz, Auenbruggerplatz 34, A-8036 Graz, Austria.
| | - Bernd Heinzl
- Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Medical University Graz, Auenbruggerplatz 34, A-8036 Graz, Austria
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Cheng KS, Liao YC, Chen MY, Kuan TC, Hong YH, Ko L, Hsieh WY, Wu CL, Chen MR, Lin CS. Circulating matrix metalloproteinase-2 and -9 enzyme activities in the children with ventricular septal defect. Int J Biol Sci 2013; 9:557-63. [PMID: 23847438 PMCID: PMC3708036 DOI: 10.7150/ijbs.6398] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Accepted: 05/21/2013] [Indexed: 11/05/2022] Open
Abstract
Ventricular septal defect (VSD) is the most common form of congenital heart diseases. Matrix metalloproteinases (MMPs) are a family of zinc-dependent endopeptidases involved in causal cardiac tissue remodeling. We studied the changes of circulating MMP-2 and MMP-9 activities in the patients with VSD severity and closure. There were 96 children with perimembranous VSD enrolled in this study. We assigned the patients into three groups according to the ratio of VSD diameter/diameter of aortic root (Ao). They were classified as below: Trivial (VSD/Ao ratio ≤ 0.2), Small (0.2 < VSD/Ao ≤ 0.3) and Median (0.3 < VSD/Ao) group. Plasma MMP-2 and MMP-9 activities were assayed by gelatin zymography. There was a significant higher MMP-2 activity in the VSD (Trivial, Small and Median) groups compared with that in Control group. The plasma MMP-9 activity showed a similar trend as the findings in MMP-2 activity. After one year follow-up, a significant difference in the MMP-9 activity was found between VSD spontaneous closure and non-closure groups. In conclusion, a positive trend between the severity of VSD and activities of MMP-2 and MMP-9 was found. Our data imply that MMP-2 and MMP-9 activities may play a role in the pathogenesis of VSD.
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Affiliation(s)
- Kun-Shan Cheng
- Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan
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8
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Echocardiography in the Adult with Congenital Heart Disease. CARDIOVASCULAR MEDICINE 2007. [DOI: 10.1007/978-1-84628-715-2_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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9
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Mansencal N, Martin F, Farcot JC, Digne F, Joseph T, Pilliére R, Redheuil A, Lacombe P, Dubourg O. Echocardiographic automated cardiac output measurement of pulmonary output and quantification of intracardiac shunt. Int J Cardiol 2006; 104:25-31. [PMID: 16137505 DOI: 10.1016/j.ijcard.2004.09.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2004] [Revised: 06/23/2004] [Accepted: 09/04/2004] [Indexed: 11/26/2022]
Abstract
BACKGROUND The quantification of intracardiac shunt (ICS) with echocardiographic pulsed-wave Doppler (PWD) method using pulmonary-to-systemic flow ratio (QP/QS ratio) remains difficult and may induce false quantification of pulmonary output. We sought to validate the recent echocardiographic automated cardiac output measurement (ACM) for the calculation of pulmonary output and the quantification of ICS in adults. METHODS One hundred and twenty consecutive patients were divided in 1) 40 patients who underwent echocardiographic and invasive explorations (group I) with groups IA (quantification of ICS using ACM, PWD and invasive oximetric methods in 20 patients) and IB (calculation of pulmonary output with ACM, PWD and thermodilution methods in 20 patients); 2) 80 patients underwent calculation of aortic and pulmonary outputs using echocardiographic ACM and PWD methods (group II). RESULTS The feasibility of ACM and conventional PWD methods for the calculation of pulmonary output was respectively 93.3% and 90%. Correlations between ACM and invasive pulmonary output were strong (r2=0.92 vs. r2=0.80 for PWD). The best correlation and agreement between invasive and echocardiographic QP/QS ratio were observed with ACM (r=0.96 vs. r=0.82 for PWD). Intracardiac shunts were best-classified with ACM, as compared to PWD (respectively 94% and 72%); sensitivities and specificities for evaluation of significant ICS were 92.3% and 100% with ACM (85% and 40% with PWD). CONCLUSIONS This study shows that ACM is a reliable and accurate echocardiographic method for calculating pulmonary output and quantifying ICS in adults and may be routinely performed in clinical practice.
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Affiliation(s)
- Nicolas Mansencal
- Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Ambroise Paré University Hospital, Boulogne, Service de Cardiologie, 9 avenue Charles de Gaulle, 92100 Boulogne, France.
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10
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Lindblade CL, Schamberger MS, Darragh RK, Cordes TM. Use of peak Doppler gradient across ventricular septal defect leads to underestimation of right-sided pressures in a patient with M-shaped Doppler signal: A case report. J Am Soc Echocardiogr 2004; 17:1207-9. [PMID: 15502800 DOI: 10.1016/j.echo.2004.06.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Christopher L Lindblade
- Department of Pediatrics, James Whitcomb Riley Hospital for Children, Indianapolis, IN 46202, USA
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11
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Schamberger MS, Farrell AG, Darragh RK, Cordes TM, Ensing GJ. Use of peak Doppler gradient across ventricular septal defects leads to underestimation of right-sided pressures in patients with "sloped" Doppler signals. J Am Soc Echocardiogr 2001; 14:1197-202. [PMID: 11734787 DOI: 10.1067/mje.2001.116351] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In patients with "sloped" appearance of the Doppler signal across a ventricular septal defect (VSD), the peak Doppler velocity seems to overestimate the catheterization-derived peak-to-peak gradient, resulting in underestimation of right-sided heart pressures. In 11 patients with sloped Doppler signals across the VSD, ventricular pressure tracings were compared with simultaneous recordings of the Doppler signal. The average peak Doppler gradient (40.2 +/- 19.2 mm Hg) overestimated the catheterization-derived peak-to-peak gradient (20.2 +/- 13.6 mm Hg) significantly (P < or =.001). Doppler mean gradient (20.2 +/- 11.3 mm Hg; P = ns) and end-systolic gradient (17.0 +/- 12.5 mm Hg; P < or =.05) were closer estimates of the catheterization peak-to-peak gradient. All Doppler gradients showed good correlation to the catheterization peak-to-peak gradient with r2 values of 0.77, 0.73, and 0.91. We conclude that Doppler mean or end-systolic gradients should be used for calculation of right-sided heart pressures in this patient population.
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Affiliation(s)
- M S Schamberger
- Department of Pediatrics, Section of Pediatric Cardiology, James Whitcomb Riley Hospital for Children, Indiana University, Indianapolis 46202-5225, USA.
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13
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Kubo N, Tomita H, Fuse S, Abe N, Hatakeyama K, Chiba S. Helical computer assisted tomography in pulmonary hypertension complicating left-to-right shunts--correlation with pulmonary hemodynamics. JAPANESE CIRCULATION JOURNAL 2001; 65:188-92. [PMID: 11266193 DOI: 10.1253/jcj.65.188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The present study analyzed the helical computer-assisted tomography (CAT) findings in 30 patients with pulmonary hypertension (PH) associated with left-to-right shunts; specifically, ventricular septal defect, 23; atrioventricular septal defect, 6; patent ductus arteriosus, 1. Eight patients had 21 trisomy. Age ranged from 1 to 18 (mean, 4.1) months, and body weight ranged from 2.6 to 10.7 (mean, 4.9) kg. In all patients, the chest CAT revealed patchy areas of high and low attenuation (mosaic pattern) and regional atelectasis in the lung fields. The volume of low attenuated lesions and of atelectasis, and the total lung volume were derived from integration of areas measured on the CAT image. The ratios of low attenuated lesion/total lung volume (Lo), volume of atelectasis/ total lung volume (Ate) and low attenuated lesion and volume of atelectasis/total lung volume (Lo&Ate) were compared with hemodynamic parameters measured at cardiac catheterization. The pulmonary to systemic resistance ratio correlated with Lo (r=0.61, p<0.01) and Lo&Ate (r=0.69, p<0.01), whereas the pulmonary vascular resistance correlated with Ate (r=0.53, p<0.01). Lo, Ate and Lo&Ate in the chest CAT are reliable parameters that can be used to estimate pulmonary vascular resistance in patients with PH associated with left-to-right shunts.
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Affiliation(s)
- N Kubo
- Department of Pediatrics, Sapporo Medical University School of Medicine, Japan
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Didier D, Ratib O, Beghetti M, Oberhaensli I, Friedli B. Morphologic and functional evaluation of congenital heart disease by magnetic resonance imaging. J Magn Reson Imaging 1999; 10:639-55. [PMID: 10548772 DOI: 10.1002/(sici)1522-2586(199911)10:5<639::aid-jmri7>3.0.co;2-l] [Citation(s) in RCA: 72] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Magnetic resonance imaging (MRI) has evolved sufficiently to be recognized as a useful complementary noninvasive method to echocardiography in the evaluation of congenital heart disease (CHD). In some cases, MRI is superior to other imaging modalities, particularly in the evaluation of thoracic aortic anomalies and in defining the anatomy of central pulmonary arteries; it is also the procedure of choice in the postoperative follow-up of patients with CHD. Recent technological advances permit not only morphological evaluation (provided by spin-echo and MR angiographic techniques) but functional and flow information (provided by fast cine-GE and velocity-encoded sequences), causing it to be recognized by pediatric cardiologists and cardiac surgeons as an unavoidable technique for pre- and postoperative evaluation of some CHD. This review describes the various techniques used in the evaluation of CHD with emphasis on recent developments as well as recognized clinical applications. J. Magn. Reson. Imaging 1999;10:639-655.
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Affiliation(s)
- D Didier
- Départements de Radiologie et Cardiologie Pédiatrique, Hôpital Cantonal Universitaire de Genève, 1211 Geneva 14, Switzerland.
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Dall'Agata A, Cromme-Dijkhuis AH, Meijboom FJ, McGhie JS, Bol-Raap G, Nosir YF, Roelandt JR, Bogers AJ. Three-dimensional echocardiography enhances the assessment of ventricular septal defect. Am J Cardiol 1999; 83:1576-9, A8. [PMID: 10363878 DOI: 10.1016/s0002-9149(99)00155-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
By 3-dimensional echocardiography, the location, relation to the aortic and tricuspid valve, and the size of the ventricular septal defect was assessed and compared with 2-dimensional echocardiography and intraoperative findings. We concluded that 3-dimensional echocardiography accurately assesses the anatomy of the ventricular septal defect, provides additional information, and can be considered a valuable preoperative diagnostic tool.
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Affiliation(s)
- A Dall'Agata
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
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16
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Abstract
Left to right shunts like atrial septal defect, ventricular septal defect and patent ducts arteriosus are commonly encountered congenital malformations of the heart. With advances in diagnostic and therapeutic technology over the last three decades the recognition and management of these lesions has markedly improved. Currently, the surgical procedures are being performed in infants and neonates with the hope that long term results would be better. Children with atrial septal defects are usually asymptomatic or mildly symptomatic and closure of the defect is best performed at 3-4 years of age. Large ventricular septal defects, on the other hand, may produce symptoms like congestive heart failure in early infancy and early closure is recommended for these babies. These defects are also known to close spontaneously and therefore in mildly symptomatic cases without pulmonary arterial hypertension, one may wait for a natural reduction in size. Surgical ligation of a patent ductus arteriosus is a safe and simple procedure and all these cases must undergo closure of the duct.
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Affiliation(s)
- A Saxena
- Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
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Konstantinides S, Geibel A, Kasper W, Just H. Noninvasive estimation of right ventricular systolic pressure in postinfarction ventricular septal rupture: an assessment of two Doppler echocardiographic methods. Crit Care Med 1997; 25:1167-74. [PMID: 9233743 DOI: 10.1097/00003246-199707000-00018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To evaluate the diagnostic accuracy of Doppler echocardiography in the assessment of right heart hemodynamics and the diagnosis of pulmonary hypertension in patients with ventricular septal rupture due to acute myocardial infarction. DESIGN A prospective, echocardiographic and right-heart catheterization study. SETTING Medical intensive care unit (ICU) of a university hospital. PATIENTS Twelve consecutive patients admitted to the ICU with the diagnosis of ventricular septal rupture in the setting of acute myocardial infarction. Confirmation of diagnosis was made during surgery (11 patients) or by autopsy (one patient). INTERVENTIONS All patients were examined by two-dimensional and Doppler echocardiography on admission and subsequently underwent bedside right-heart catheterization. MEASUREMENTS AND MAIN RESULTS After identification and localization of the rupture site by two-dimensional echocardiography and/or color flow Doppler mapping, the maximal flow velocity of the transseptal jet was measured by continuous-wave Doppler and was used to calculate the peak interventricular pressure gradient by the modified Bernoulli equation. This value was subtracted from the systolic arterial blood pressure value to estimate right ventricular systolic pressure. The values obtained correlated well with catheter-derived measurements (r2 = .71; p = .001). Furthermore, in eight (67%) patients, right ventricular systolic pressure could also be determined by Doppler interrogation of the tricuspid regurgitant jet. Direct comparison of the results of the two echocardiographic methods yielded a good correlation (r2 = .66; p = .016). CONCLUSION Doppler examination of the transseptal and tricuspid regurgitant jets is applicable to patients with ventricular septal rupture for rapid, noninvasive prediction of right ventricular hemodynamics.
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Affiliation(s)
- S Konstantinides
- Department of Cardiology and Critical Care Medicine, University Clinic of Freiburg, Germany
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Carotti A, Marino B, Bevilacqua M, Marcelletti C, Rossi E, Santoro G, De Simone G, Pasquini L. Primary repair of isolated ventricular septal defect in infancy guided by echocardiography. Am J Cardiol 1997; 79:1498-501. [PMID: 9185640 DOI: 10.1016/s0002-9149(97)00178-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Between 1989 and 1995, 96 consecutive infants affected by isolated ventricular septal defect (VSD) were submitted for primary correction at a median age of 4 months. Of the 96, 60 (group I) underwent surgery on the base of a 2-dimensional Doppler echocardiographic (DD echo) test alone. The preoperative DD echo anatomic definition of the type of VSD was confirmed at surgery in all 60 patients without false-positive results in terms of additional cardiac anomalies. There were 2 false-negatives: in 2 patients an associated cardiac anomaly was not detected by DD echo and required a second surgical procedure after postoperative cardiac catheterization. During the same period 36 infants (group II) underwent surgical closure of isolated VSD on the basis of cardiac catheterization and angiocardiography in addition to DD echo. The retrospective comparison between the 2 groups revealed no significant difference in terms of sensitivity and specificity of the diagnostic tools, early and late mortality after surgical correction, postoperative hospital stay, and need for late cardiac catheterization and surgery. We conclude that after an accurate selection, most of the infants with uncomplicated VSD can safely undergo primary repair on the basis of DD echo alone.
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Affiliation(s)
- A Carotti
- Department of Pediatric Cardiology and Cardiac Surgery, Ospedale Bambino Gesu, Rome, Italy
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Cheitlin MD, Alpert JS, Armstrong WF, Aurigemma GP, Beller GA, Bierman FZ, Davidson TW, Davis JL, Douglas PS, Gillam LD. ACC/AHA Guidelines for the Clinical Application of Echocardiography. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Clinical Application of Echocardiography). Developed in collaboration with the American Society of Echocardiography. Circulation 1997; 95:1686-744. [PMID: 9118558 DOI: 10.1161/01.cir.95.6.1686] [Citation(s) in RCA: 466] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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20
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Becker TE, Ensing GJ, Darragh RK, Caldwell RL. Doppler derivation of complete pulmonary artery pressure curves in patent ductus arteriosus. Am J Cardiol 1996; 78:1066-9. [PMID: 8916495 DOI: 10.1016/s0002-9149(96)00541-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Doppler echocardiography can be used in patients with a patent ductus arteriosus to generate complete pulmonary artery pressure curves. This technique provides a dynamic evaluation of changes in pulmonary artery pressures throughout the cardiac cycle and provides more hemodynamic information than single-point Doppler velocity methods of estimating pulmonary artery pressures.
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Affiliation(s)
- T E Becker
- Department of Pediatrics, Indiana University, Indianapolis, USA
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21
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Reef VB. Evaluation of ventricular septal defects in horses using two-dimensional and Doppler echocardiography. Equine Vet J 1995:86-95. [PMID: 8933074 DOI: 10.1111/j.2042-3306.1995.tb04994.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Ventricular septal defects (VSDs) were diagnosed in 27 horses; in 26 affected horses systolic murmurs were detected over both sides of the chest. Holodiastolic decrescendo murmurs were also detected in 5 horses. Standardbreds and Arabian horses were over-represented, while Thoroughbred horses were under-represented, when compared to the hospital population (P < 0.0001). Five horses had previously raced successfully, one 2-year-old was training successfully and close to racing, and 4 horses had competed successfully in other types of competition. Eleven horses had a history of exercise intolerance or poor performance, 5 horses were stunted and 3 horses were in congestive heart failure at the time of presentation. The VSD murmur was detected as an incidental finding in 14 horses. Membranous VSD were most commonly detected (in 23/27 affected horses) and were typically found underneath the septal leaflet of the tricuspid valve and the right and/or noncoronary leaflet of the aortic valve. Muscular VSDs were much less common and were located in any portion of the muscular septum. The VSDs ranged in size from 1-4.6 cm (maximal diameter) in affected horses. A left to right shunt through the VSD was detected in 26/27 affected horses with Doppler echocardiography. The peak velocity of shunt flow detected through the VSD was 0-5.8 m/s. The interventricular pressure gradients estimated from the peak shunt velocity obtained with Doppler echocardiography were 0-135 mmHg. Right ventricular pressures estimated with Doppler echocardiography were 15-84 mmHg, similar to invasively obtained measurements of right ventricular pressure in 80% of horses in which right sided cardiac catheterisation was performed (n = 5). Left ventricular and left atrial volume overload was detected in the majority (23/27) of horses. Right atrial and right ventricular volume overload was severe in 3 horses with muscular VSDs, mild in 1 horse with a perimembranous VSD, and mild in 2 horses with membranous VSDs. Concurrent left ventricular dysfunction was detected in 2 horses. Aortic valve prolapse was seen in 7 horses associated with the membranous location of the VSD; 6 of these horses had very mild (1+) or mild (2+) aortic regurgitation. Severe (4+) aortic regurgitation was present in one horse, severe mitral regurgitation in 2 horses, severe tricuspid regurgitation in 3 horses, and severe pulmonary regurgitation was detected in 2 horses. Mitral valve prolapse, tricuspid valve dysplasia, a flail aortic valve leaflet, and a bicuspid pulmonary valve were additional findings detected in one horse each. Post mortem examinations were performed in 8 horses which confirmed the echocardiographic findings. Sixteen out of 27 horses had a history of racing or competing successfully either before or after the diagnosis of the VSD. Two horses were useful pleasure horses, 3 horses presented in congestive heart failure, 1 horse developed signs of congestive heart failure, 2 horses were lost to follow-up and 2 are still alive but are small and stunted. The successful racehorses usually had a membranous VSD that measured < or = 2.5 cm in its largest diameter and a peak velocity of shunt flow through the VSD of > or = 4 m/s. Two-dimensional (2-D) and Doppler echocardiography is useful in assessing the haemodynamic significance of VSDs in horses and can be used to help formulate a prognosis for life and performance.
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Affiliation(s)
- V B Reef
- Department of Clinical Studies (Section of Medicine), New Bolton Center, University of Pennsylvania, Kennett Square 19348, USA
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22
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Stojnić B, Pavlović P, Ponomarev D, Aleksandrov R, Prcović M. Bidirectional shunt flow across a ventricular septal defect: pulsed Doppler echocardiographic analysis. Pediatr Cardiol 1995; 16:6-11. [PMID: 7753707 DOI: 10.1007/bf02310326] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Pulsed Doppler echocardiographic and hemodynamic examinations were performed in 31 patients (mean age 17.8 years) with isolated ventricular septal defect (VSD). Three groups were studied: group I (n = 6) patients had severe pulmonary vascular obstructive disease (PVOD); group II (n = 12) patients had pulmonary hypertension (PH) without severe PVOD; group III (n = 13) patients had no PH. Bidirectional shunting was detected in 9 VSD patients (6 in group I and 3 in group II). Patients with low to moderately elevated right ventricular pressures demonstrated left-to-right shunting across the defect throughout the cardiac cycle. When systolic pressure in the right ventricle reached approximately 60% of the left ventricular pressure, right-to-left shunting occurred across the defect during early and mid diastole. However, in patients with Eisenmenger syndrome (group I) the right-to-left shunting occurred during late systole with continuation during the early and mid diastolic period. The earlier occurrence of right-to-left shunting (index < 0.5 second) signifies the presence of severe PVOD.
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Affiliation(s)
- B Stojnić
- Department of Cardiology, Military Medical Academy, Belgrade, Yugoslavia
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23
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Rivera JM, Siu SC, Handschumacher MD, Lethor JP, Guerrero JL, Vlahakes GJ, Mitchell JD, Weyman AE, King ME, Levine RA. Three-dimensional reconstruction of ventricular septal defects: validation studies and in vivo feasibility. J Am Coll Cardiol 1994; 23:201-8. [PMID: 8277082 DOI: 10.1016/0735-1097(94)90521-5] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVES The purpose of this study was to demonstrate the feasibility of in vivo three-dimensional reconstruction of ventricular septal defects and to validate its quantitative accuracy for defect localization in excised hearts (used to permit comparison of three-dimensional and direct measurements without cardiac contraction). BACKGROUND Appreciating the three-dimensional spatial relations of ventricular septal defects could be useful in planning surgical and catheter approaches. Currently, however, echocardiography provides only two-dimensional views, requiring mental integration. A recently developed system automatically combines two-dimensional echocardiographic images with their spatial locations to produce a three-dimensional construct. METHODS Surgically created ventricular septal defects of varying size and location were imaged and reconstructed, along with the left and right ventricles, in the beating heart of six dogs to demonstrate the in vivo feasibility of producing a coherent image of the defect that portrays its relation to surrounding structures. Two additional gel-filled excised hearts with defects were completely reconstructed. Quantitative localization of the defects relative to other structures (ventricular apexes and valve insertions) was then validated for seven defects in excised hearts. The right septal margins of the exposed defects were also traced and compared with their reconstructed areas and circumferences. RESULTS The three-dimensional images provided coherent images and correct spatial appreciation of the defects (two inlet, two trabecular, one outlet and one membranous Gerbode in vivo; one inlet and one apical in excised hearts). The distances between defects and other structures in the excised hearts agreed well with direct measures (y = 1.05x-0.18, r = 0.98, SEE = 0.30 cm), as did reconstructed areas (y = 1.0x-0.23, r = 0.98, SEE = 0.21 cm2) and circumferences (y = 0.97x + 0.13, r = 0.97, SEE = 0.3 cm). CONCLUSIONS Three-dimensional reconstruction of ventricular septal defects can be achieved in the beating heart and provides an accurate appreciation of defect size and location that could be of value in planning interventions.
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Affiliation(s)
- J M Rivera
- Noninvasive Cardiac Laboratory, Massachusetts General Hospital, Boston 02114
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24
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25
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Abstract
Ventricular septal defects account for 10% to 15% of all congenital heart defects observed in adults. The type of defects observed tend to fall at the extreme ends of the spectrum: small restrictive defects with minimal shunts, and large nonrestrictive defects associated with severe occlusive pulmonary vascular disease. Doppler echocardiography has evolved into a powerful diagnostic modality that comprehensively evaluates the anatomical and pathophysiological consequences of a ventricular septal defect. The spectrum of findings caused by ventricular septal defects is the subject of this review.
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Affiliation(s)
- P S Rahko
- Section of Cardiology, Department of Medicine, University of Wisconsin Medical School, Madison 53792
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26
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Sutherland GR. Has echo/Doppler influenced the practice of paediatric cardiology? INTERNATIONAL JOURNAL OF CARDIAC IMAGING 1993; 9 Suppl 2:17-26. [PMID: 8409549 DOI: 10.1007/bf01143176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- G R Sutherland
- Department of Cardiology, Western General Hospital, Edinburgh, Scotland
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27
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Ramaciotti C, Chin AJ. Noninvasive evaluation of newborns with congenital heart disease. J Intensive Care Med 1993; 8:130-43. [PMID: 10148599 DOI: 10.1177/088506669300800304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Over the last decade, diagnosis and management of neonates with congenital heart disease have been greatly influenced by the constant expansion of noninvasive methods. We classify the most common congenital defects presenting in the first 2 weeks of life, based on clinical presentation and hemodynamic characteristics, followed by a discussion of echocardiographic findings in the most common congenital heart lesions and how ultrasound techniques can help solve problems frequently encountered during the early postoperative period.
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Affiliation(s)
- C Ramaciotti
- Non-Invasive Laboratories, Children's Hospital of Philadelphia, PA 19104
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28
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Ge Z, Zhang Y, Kang W, Fan D, Ji X, Duran C. Noninvasive evaluation of right ventricular and pulmonary artery systolic pressures in patients with ventricular septal defects: simultaneous study of Doppler and catheterization data. Am Heart J 1993; 125:1073-81. [PMID: 8465730 DOI: 10.1016/0002-8703(93)90116-q] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The method for evaluating right ventricular and pulmonary artery systolic pressures by subtracting the systolic pressure gradient across the ventricular septal defect from the cuff systolic blood pressure is documented. To confirm the reliability and accuracy of this method, simultaneous continuous wave Doppler echocardiography and left and right cardiac catheterization were performed in 66 patients with congenital ventricular septal defects. The comparisons between the Doppler-derived right ventricular or pulmonary artery systolic pressures and those measured by catheterization yielded an excellent correlation (r = 0.969, y = 1.035x - 3.627, SEE = 8.2 mm Hg, p < 0.001 and r = 0.972, y = 1.012x - 2.904, SEE = 7.6 mm Hg, p < 0.001), respectively. There was a close agreement between the Doppler-derived right ventricular or pulmonary artery systolic pressures and those measured by catheters, and the differences between the two measurements did not differ significantly from zero. It is concluded that Doppler echocardiography offers a reliable and accurate method for noninvasive assessment of right ventricular and pulmonary artery systolic pressures in patients with ventricular septal defects.
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Affiliation(s)
- Z Ge
- Department of Cardiovascular Diseases, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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29
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Ge Z, Zhang Y, Kang W, Fan D, An F. Noninvasive evaluation of interventricular pressure gradient across ventricular septal defect: a simultaneous study of Doppler echocardiography and cardiac catheterization. Am Heart J 1992; 124:176-82. [PMID: 1615803 DOI: 10.1016/0002-8703(92)90938-r] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Simultaneous continuous-wave Doppler echocardiography and left- and right-sided cardiac pressure measurements were performed during cardiac catheterization in 64 patients with a congenital ventricular septal defect (VSD). The peak-to-peak pressure gradient across the VSD on cardiac catheterization ranged from 0 to 109 mm Hg (61 +/- 31.7 mm Hg). The peak shunt velocity and peak pressure gradient across the VSD on Doppler ultrasound imaging ranged from 0.96 to 5.21 m/sec (3.75 +/- 1.16 m/sec) and from 4 to 105 mm Hg (62 +/- 29.8 mm Hg), respectively. Doppler measurements of the peak interventricular pressure gradient correlated well with measurements obtained by cardiac catheterization (r = 0.98, standard error of estimate = 6.3 mm Hg, p less than 0.001). Doppler ultrasound imaging yielded information comparable to that obtained by catheterization and provided an accurate method of measuring the pressure gradient across the VSD, which is a useful parameter for the assessment of pulmonary artery systolic pressure in patients with a VSD, without a left or right ventricular outflow tract obstruction.
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Affiliation(s)
- Z Ge
- Department of Cardiology, Shandong Medical University Hospital, Jinan, China
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30
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Moises VA, Maciel BC, Hornberger LK, Murillo-Olivas A, Valdes-Cruz LM, Sahn DJ, Weintraub RG. A new method for noninvasive estimation of ventricular septal defect shunt flow by Doppler color flow mapping: imaging of the laminar flow convergence region on the left septal surface. J Am Coll Cardiol 1991; 18:824-32. [PMID: 1869745 DOI: 10.1016/0735-1097(91)90808-m] [Citation(s) in RCA: 54] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
An accurate but simple and noninvasive method for quantifying flow across a ventricular septal defect has yet to be implemented for routine clinical use. A region of flow convergence is commonly imaged by Doppler color flow mapping on the left septal surface of the ventricular septal defect, appearing as a narrowed region of laminar flow with aliased flow velocities entering the orifice. If the first aliasing region represents a hemispheric isovelocity boundary of a surface of flow convergence and all flow at this surface crosses the ventricular septal defect, the flow through the defect can be estimated by using the radius (R), measured from the first alias to the orifice, and the Nyquist limit (NL) velocity (the flow velocity at the first alias). Doppler color flow imaging was performed in 18 children with a single membranous ventricular septal defect undergoing cardiac catheterization at a mean age of 29.8 months (Group I). Indexes of maximal flow rate across the defect were developed from either the radius or the area, obtained by planimetry, of the first alias, based on Doppler color flow images. All indexes were corrected for body surface area and compared with shunt flow (Qp-Qs) and pulmonary to systemic flow ratio (Qp/Qs) determined at cardiac catheterization. Doppler color flow indexes derived from images of flow convergence in both the long-axis (n = 15) and oblique four-chamber (n = 10) views correlated closely with Qp/Qs (r = 0.71 to 0.92) and Qp - Qs (r = 0.69 to 0.97).(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- V A Moises
- Division of Pediatric Cardiology, University of California, San Diego
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31
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Andrade JL. The role of Doppler echocardiography in the diagnosis, follow-up, and management of ventricular septal defects. Echocardiography 1991; 8:501-16. [PMID: 10149268 DOI: 10.1111/j.1540-8175.1991.tb01010.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The defects of the ventricular septum have received special attention from investigators working in echocardiography. The method showed an incomparable capability to identify all the morphological features of the defects. The increasing improvement in definition of transducers associated with conventional and color Doppler contributed significantly to the reliability to detect most of the defects. The great majority of associated lesions can be easily identified and serial examinations allow prediction of which defect may become smaller or even close spontaneously as well as which have acquired deleterious changes in the heart. Several authors have shown very good statistical correlations between echocardiographic indices and hemodynamic parameters in patients with this type of defect. Doppler echocardiography has become an invaluable tool in the diagnosis and follow-up of ventricular septal defect reducing the need for cardiac catheterization and helping management of these patients.
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Affiliation(s)
- J L Andrade
- Pediatric Cardiology Division, Escola Paulista de Medicina, Sao Paulo, Brazil
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32
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Linker DT, Rossvoll O, Chapman JV, Angelsen BA. Sensitivity and speed of colour Doppler flow mapping compared with continuous wave Doppler for the detection of ventricular septal defects. Heart 1991; 65:201-3. [PMID: 2029441 PMCID: PMC1024580 DOI: 10.1136/hrt.65.4.201] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Twenty nine patients (aged from three months to 37 years) with confirmed or suspected ventricular septal defects were studied separately by three examiners who used colour flow mapping and imaging, or continuous wave Doppler and imaging, or a combined reference examination. Colour flow mapping identified 19 of the 25 patients with a ventricular septal defect, continuous wave Doppler echocardiography identified 18, and the combined reference examination identified 24. Two of four patients without ventricular septal defect had a false positive result with colour flow mapping and none had a false positive result with continuous wave Doppler examination. During the reference examination continuous wave Doppler identified 24 patients with ventricular septal defects and colour flow mapping identified 23. In two patients a second ventricular septal defect was found by colour flow mapping, and confirmed by continuous wave Doppler. There was no significant difference in time to diagnosis between the two techniques. Colour flow mapping aids identification of multiple ventricular septal defects but is not faster and has lower specificity than continuous wave Doppler. A combination of the two techniques gave the highest sensitivity and specificity.
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Affiliation(s)
- D T Linker
- Department of Biomedical Engineering, University of Trondheim, Norway
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33
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Ewy GA, Appleton CP, Demaria AN, Feigenbaum H, Ronan JA, Skorton DJ, Tajik AJ, Williams RG, Rogers EW, Fisch C, Beller GA, DeSanctis RW, Dodge HT, Kennedy J, Reeves T, Weinberg SL. ACC/AHA guidelines for the clinical application of echocardiography. J Am Coll Cardiol 1990. [DOI: 10.1016/0735-1097(90)90294-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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34
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ACC/AHA guidelines for the clinical application of echocardiography. A report of the American College of Cardiology/American Heart Association Task Force on Assessment of Diagnostic and Therapeutic Cardiovascular Procedures (Subcommittee to Develop Guidelines for the Clinical Application of Echocardiography). Circulation 1990; 82:2323-45. [PMID: 2242558 DOI: 10.1161/01.cir.82.6.2323] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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35
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Garg A, Shrivastava S, Radhakrishnan S, Dev V, Saxena A. Doppler assessment of interventricular pressure gradient across isolated ventricular septal defect. Clin Cardiol 1990; 13:717-21. [PMID: 2257713 DOI: 10.1002/clc.4960131009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Continuous wave Doppler ultrasound was used to estimate the pressure gradient between the right and left ventricle for assessment of pulmonary arterial systolic pressure in 30 patients with isolated ventricular septal defect and for subsequent comparison with similar data obtained on cardiac catheterization. The age of the patients ranged from 8 months to 45 years (6.8 +/- 8.6 years). No patient had right or left ventricular outflow tract obstruction. Doppler measurements were done within 24 h of cardiac catheterization. Pressure gradient across ventricular septal defect on cardiac catheterization ranged from 7 to 95 mmHg (48 +/- 24 mmHg) and that on Doppler assessment ranged from 8 to 78 mmHg (42 +/- 20 mmHg). Doppler measurements of interventricular pressure gradient correlated well with those obtained on cardiac catheterization (r = 0.90, p less than 0.001). Correlation was better in patients with pressure gradient across ventricular septal defect less than 75 mmHg (r = 0.96). Correlation was poor in three of five patients with very small ventricular septal defects (interventricular pressure gradient greater than 75 mmHg) because the jet used was not ideal. Thus continuous wave Doppler ultrasound is an accurate noninvasive means of measuring pressure gradient across ventricular septal defect, which is a useful parameter for assessment of pulmonary artery systolic pressure in patients with isolated ventricular septal defect without right and left ventricular outflow tract obstruction.
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Affiliation(s)
- A Garg
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi
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36
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Affiliation(s)
- A R Snider
- Department of Pediatrics, C.S. Mott Children's Hospital, University of Michigan Medical Center, Ann Arbor 48109
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37
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Abstract
M-mode and two-dimensional echocardiography have greatly enhanced the evaluation of animals with congenital cardiac disease. Structural abnormalities can be seen and hemodynamic alterations inferred, e.g., ventricular wall concentric hypertrophy indicating pressure overload to the respective ventricle. Interrogation of the diseased heart by Doppler echocardiography allows acquisition of more direct hemodynamic information without cardiac catheterization, which enables the clinician to give a more precise description of a congenital abnormality. The purpose of this study is to illustrate and describe abnormal blood-flow patterns in selected congenital cardiac defects in animals. Basic background information concerning Doppler echocardiographic principles, flow patterns, and calculations will be briefly discussed. For more detailed descriptions other references should be sought. Interpretation of Doppler echocardiography in animals is based primarily on data derived from human studies since studies involving measurable numbers of veterinary patients have not yet been completed.
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Affiliation(s)
- N S Moise
- Department of Clinical Sciences, New York State College of Veterinary Medicine, Cornell University, Ithaca 14853
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38
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Affiliation(s)
- T Zellers
- Department of Pediatrics, University of Virginia Medical Center, Charlottesville 22908
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39
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Hornberger LK, Sahn DJ, Krabill KA, Sherman FS, Swensson RE, Pesonen E, Hagen-Ansert S, Chung KJ. Elucidation of the natural history of ventricular septal defects by serial Doppler color flow mapping studies. J Am Coll Cardiol 1989; 13:1111-8. [PMID: 2926062 DOI: 10.1016/0735-1097(89)90270-2] [Citation(s) in RCA: 59] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Two-dimensional echocardiography has provided information to aid in the diagnosis and management of infants with ventricular septal defect, but its inability to resolve very small ventricular septal defects and problems with defining ventricular septal defect orifice size (because of overlying muscle or tricuspid tissue) have made it unsuitable as a standard for defining the natural history of ventricular septal defect. In this study, 114 serial two-dimensional Doppler color flow mapping studies were performed to define ventricular septal defect anatomy, location and color flow diameter as an indicator of shunt size in 66 patients (over a 40 month period). Twenty-five patients first studied at 6 months of age (mean age at most recent study 15.9 months) had congestive heart failure and 41 (mean age 45 months) did not. In the congestive heart failure group, there were 24 perimembranous and 1 muscular ventricular septal defect and aneurysm formation was present in 17. Mean (+/- SD) color flow diameter was 8.2 +/- 1.9 mm and color flow diameter/aortic root diameter ratio was 0.63. In the 30 patients who underwent cardiac catheterization, color flow diameter bore a close relation to angiographic diameter (r = 0.96) and pulmonary/systemic flow ratio (Qp/Qs) (r = 0.88). In the patients with congestive heart failure, 4 of the 25 ventricular septal defects, all with aneurysm present or positioned adjacent to the tricuspid valve, became smaller but none closed. Of the 41 patients without congestive heart failure, 21 had a perimembranous defect (15 with aneurysm), 18 had a muscular ventricular septal defect and 2 had a supracristal ventricular septal defect.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- L K Hornberger
- Department of Pediatrics, University of California, San Diego
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40
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Williams RG. Perioperative echocardiographic evaluation. INTERNATIONAL JOURNAL OF CARDIAC IMAGING 1989; 4:29-31. [PMID: 2664012 DOI: 10.1007/bf01795116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The integration of pre-, intra- and postoperative echo-cardiography has advanced the health of patients with congenital heart disease by providing an accurate initial evaluation, improving the timing and choice of intervention and detecting residual abnormalities in a timely fashion.
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Affiliation(s)
- R G Williams
- UCLA Medical Center, Division of Pediatric Cardiology
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41
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Houston AB, Lim MK, Doig WB, Reid JM, Coleman EN. Doppler assessment of the interventricular pressure drop in patients with ventricular septal defects. BRITISH HEART JOURNAL 1988; 60:50-6. [PMID: 3044413 PMCID: PMC1216514 DOI: 10.1136/hrt.60.1.50] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Doppler ultrasound was used to assess the pressure drop between the ventricles in 109 infants and children (61 less than two years old) with a ventricular septal defect who underwent cardiac catheterisation. The pressure in both ventricles was measured at catheterisation in 103 patients either simultaneously through two catheters (41) or with a single catheter withdrawn across the septum or removed from one ventricle to the other (62). When pressure was measured simultaneously with two catheters (41 patients) the peak to peak and instantaneous gradients showed a maximum difference of 20 mm Hg with levels within 10 mm Hg of each other in 36. Comparison of the difference in the gradients with the average of the measurements demonstrated a tendency for Doppler to underestimate the difference when it was high (greater than 50 mm Hg) and overestimate it when it was low. A Doppler estimate of a low pressure difference between the ventricles indicates pulmonary arterial hypertension and a high one low pulmonary artery pressure, but in the intermediate group Doppler is as yet not sufficiently sensitive to allow selection of those patients who require further investigation and possible operation. Doppler ultrasound was found to be a sensitive method of detecting a very small ventricular septal defect. Thus although Doppler is a very useful means of assessing and following patients with a ventricular septal defect, further studies are required to determine its exact place in clinical practice.
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Affiliation(s)
- A B Houston
- Department of Cardiology, Royal Hospital for Sick Children, Glasgow
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42
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Abstract
Doppler ultrasound has rapidly become a valuable tool in the noninvasive investigation of cardiac hemodynamics. Although based on secure principles, accurate application of this methodology to quantitative measurements necessitates a thorough understanding of both Doppler physics and instrumentation. Over the past several years a large body of clinical and animal data verifying the accuracy of Doppler determination of pressure and flow data at various sites in the cardiovascular system, as well as the potential sources of error in acquisition and interpretation of blood velocity recordings, has been published. Quantitative use of Doppler in congenital heart disease, with emphasis on limitations of existing studies and issues particular to this patient population, is reviewed.
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Affiliation(s)
- S D Colan
- Department of Cardiology, Children's Hospital, Boston, MA 02115
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43
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SNIDER AREBECCA. Prediction of Intracardiac Pressures and Assessment of Ventricular Function with Doppler Echocardiography. Echocardiography 1987. [DOI: 10.1111/j.1540-8175.1987.tb01342.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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44
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STEVENSON JGEOFFREY. The Use of Doppler Echocardiography for Detection and Estimation of Severity of Patent Ductus Arteriosus, Ventricular Septal Defect, and Atrial Septal Defect. Echocardiography 1987. [DOI: 10.1111/j.1540-8175.1987.tb01343.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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45
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MURPHY DANIELJ, LUDOMIRSKY ACHI, DANFORD DAVIDA, HUHTA JAMESC. Doppler Echocardiography in Pulmonary Stenosis. Echocardiography 1987. [DOI: 10.1111/j.1540-8175.1987.tb01333.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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46
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Ludomirsky A, Huhta JC, Vick GW, Murphy DJ, Danford DA, Morrow WR. Color Doppler detection of multiple ventricular septal defects. Circulation 1986; 74:1317-22. [PMID: 3779917 DOI: 10.1161/01.cir.74.6.1317] [Citation(s) in RCA: 61] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Combined two-dimensional and Doppler echocardiography has a high sensitivity and specificity for detection of isolated perimembranous ventricular septal defects. However, muscular or multiple ventricular septal defects may be difficult to diagnose with noninvasive methods, particularly in older children, necessitating angiography for accurate diagnosis. Detection of single and multiple ventricular septal defects with two-dimensional color flow mapping was compared with detection by standard two-dimensional imaging and Doppler. Both techniques were compared with four-chamber left ventricular angiography. Fifty-one patients (age 3 months to 25 years, mean 5.6 years) were studied. Eighteen had solitary ventricular septal defects, 18 had multiple ventricular septal defects, and 15 patients with intact ventricular septum served as a control group. At least one ventricular septal defect was detected by color Doppler and two-dimensional/Doppler methods in all patients with ventricular septal defect proved by angiography with no false positives. In the detection of multiple ventricular septal defects, the sensitivity of color Doppler was 72% and that of two-dimensional/Doppler was 38% (100% specificity in both). Color Doppler failed to identify multiple ventricular septal defects in five patients (two weighing less than 4 kg and three with reduced pulmonary blood flow). However, no large additional muscular defects were missed by imaging and color Doppler. Color Doppler is useful for the detection of ventricular septal defects and has higher sensitivity than two-dimensional/Doppler for multiple ventricular septal defects. The contribution of color Doppler appears to be in the detection of additional small muscular ventricular septal defects.
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