Color Doppler flow mapping in patients with coarctation of the aorta: new observations and improved evaluation with color flow diameter and proximal acceleration as predictors of severity.

Abstract

We performed color Doppler flow mapping in 15 patients, 1 week to 17 years old (mean 42 months), with coarctation of the aorta that was confirmed subsequently by angiography and/or surgery. Twelve patients had native coarctation and three had mild recoarctation after surgical repair. Color Doppler flow maps were analyzed with a digital analysis package and a Sony computer system. The diameter in the region of coarctation from the color Doppler flow map (mean = 2.0 0.8 mm [SD]) correlated well with the coarctation diameter measured at angiography (mean = 1.8 0.8 mm; r=.83, SEE 0.43 mm) in the 10 patients with native coarctation undergoing angiography, but the coarctation diameter measured by two-dimensional echocardiography (3.9 ± 1.5 mm) was poorly predictive of the angiographic severity (r=.23). Additionally, spatial acceleration was seen in all patients proximal to the coarctation site, with an aliased and accelerating stream narrowing progressively as it proceeded toward the coarctation site, a pattern that is not seen in healthy subjects. Computer analysis of the color Doppler images provided pseudo three-dimensional and digital velocity maps for blue, red, and green (turbulent) flow velocities to allow an enhanced appreciation of the accelerating stream, easily separating this from normal desending aortic aliasing patterns. The narrowing of the acceleration area in the proximal descending aorta (distal/proximal acceleration zone ratio) was also predictive of the angiographic severity of coarctation (r = .83). The distribution of low-level turbulence seen proximally paralleled the distribution of the proximal accelerating stream. Highly turbulent flow distal to the coarctation was identified in all patients, continuing into diastole in the seven patients with increased diastolic flow velocities on continuous-wave Doppler images. Color Doppler flow mapping allows new observations of coarctation flow diameter, spatial aortic acceleration, and turbulence in the proximal descending aorta that enhance the noninvasive assessment of patients with coarctation of the aorta. Circulation 77, No. 4, 736-744, 1988. TWO-DIMENSIONAL echocardiography has been quite useful for the noninvasive assessment of patients with coarctation of the aorta1'2 and when high-resolution images are obtained many patients can safely undergo surgery without the need for a confirmatory invasive study. In normal newborn infants, however, mild isthmic narrowing is a common finding and confusion may arise in attempts to diagnose coarctation From the Divison

Hypoplasia of the aortic arch

“…Наличие антеградного кровотока в диастолу подтверж-дает гемодинамическую значимость обструкции аорты [25,26]. Ультразвуковая локация позволяет получить изоб-ражения коарктации аорты с гипоплазией дуги и смеж-ных структур, но иногда это оказывается невозможным в связи с экранированием сужения легочной тканью.…”

Noninvasive quantitative evaluation of the morphology of the major pulmonary artery branches in cyanotic congenital heart disease. Angiocardiographic and echocardiographic correlative study.

“…A similar finding has been reported in identification and measurements of the region of coarctation in patients with coarctation of the aorta. 21 On the other hand, the severity of intravascular stenosis is commonly assessed by estimating pressure gradients across the stenosis by using continuous wave Doppler echocardiography. All patients in this study had pulmo- nary obstruction with or without systemic-to-pulmonary shunt or PA banding.…”

Comparison of the proximal flow convergence method and the jet area method for the assessment of the severity of tricuspid regurgitation

“…The existence of a flow convergence region proximal to a restrictive orifice has been demonstrated by colour flow Doppler imaging in experimental and clinical studies [12][13][14][15] . Colour flow Doppler imaging of the proximal flow convergence region has proven to be reliable in the quantification of mitral as well as tricuspid regurgitation [13,[16][17][18] .…”