Comparison of four Doppler echocardiographic methods for calculating pulmonary-to-systemic shunt flow ratios in patients with ventricular septal defect

Sabry, Ayman; Reller, Mark D.; Silberbach, G. Michael; Rice, Mary J.; Sahn, David J.

doi:10.1016/s0002-9149(99)80627-4

Cited by 21 publications

(19 citation statements)

References 20 publications

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“…Non-invasive techniques based on echocardiography using spectral Doppler velocitytime integral and vessel area have been developed but faced with considerable limitations in terms of accuracy and reproducibility [27]. CMR flow assessment has been validated extensively in vivo and in vitro [28] with less than 5% difference when compared to Fick calculation and thermodilution.…”

Section: Flowsmentioning

confidence: 99%

Role of cardiac MRI and CT in Fontan circulation

Yeong

Loughborough

Hamilton

et al. 2017

J Congenit Heart Dis

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A Fontan circulation is a series of palliative surgical procedures, which result in the diversion of the systemic venous return into pulmonary arterial circulation without passing through a ventricle. It is one of the available surgical strategies for patients with cardiac defects that preclude a successful bi-ventricular repair, which encompass a range of complex anatomy. This surgical repair has gone through a series of modifications since the concept was introduced in 1971. Echocardiography remains a vital tool in assessing patients with Fontan circulations but its limitations are well recognised. Cross-sectional imaging modalities such as cardiac MRI and CT are essential components in the systematic clinical evaluation of these patients. The purpose of this review is to understand the information that can be obtained with each cross-sectional modality as well as highlight the challenges that each modality faces.

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Section: Flowsmentioning

confidence: 99%

Role of cardiac MRI and CT in Fontan circulation

Yeong

Loughborough

Hamilton

et al. 2017

J Congenit Heart Dis

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“…Our method of estimating RVP has been well established and is widely used because a better method of tricuspid regurgitation is not available for the majority of patients. The method for estimation of Q p :Q s in this study is not the best, but it is a good method [37] and is applicable in all VSDs.…”

Section: Discussionmentioning

confidence: 95%

“…Measurements were made between the inner border of the vessel wall during the greatest systolic expansion of the vessels. This method was shown to correlate well with the measurements of Q p :Q s derived from oxymetric data at heart catheterization but not as well as with the shunt determination through the VSD [37].…”

Section: Methodsmentioning

confidence: 92%

Regression of Right Ventricular Pressure in Ventricular Septal Defect in Infancy: A Longitudinal Color-Flow Doppler Echocardiographic Study

et al. 1999

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To determine the course of right ventricular pressure (RVP) in patients with isolated ventricular septal defect (VSD) and factors influencing it, unselected 148 infants were followed-up longitudinally with color-Doppler echocardiography from a median age of 1 month for 201 patient-years. The patients were divided into three groups by absolute echographic size of VSD: group I, 4 to 7 mm. Sixty percent belonged to group I. Muscular defects dominated in group I, perimembranous defects dominated in group II, and those with outlet extensions dominated in group III. Peak systolic RVP was obtained by Doppler-estimated difference between systolic brachial artery and peak gradient across the VSD. Initial RVP ranged between 15 and 95 mmHg and increased in parallel to the size of defect. According to the regression equations RVP decreased in general by 0.17 mmHg per month. This correlated significantly with the size of the defect. In group I, the rate of decrease was very fast and is best expressed by a log function of time (r = -0.67, r(2) = 0.45). In groups II and III the rate of decrease was less steep and had a greater variability. RVP normalized in 100% in those of group I and in 90% of group II, at median ages of 0.17 and 0.33 years, respectively. Median Q(p):Q(s) values were 1.5, 2.2, and 3.0 in groups I-III, respectively. The outcome depended on the size of VSD. Spontaneous closure was observed in 51% of group I, 10% of group II, and none of group III. The rate was higher in muscular defects. Congestive heart failure was present in 53% and 100% in groups II and III, respectively. Death rate was 2.03%, all in patients with large defects. It is concluded that the temporal course of RVP with time can be estimated fairly well by the regression equation presented in relation to the initial size of the VSD.

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“…Because the flow rate and vessel area are not measured directly, the accuracy and reproducibility of this method is limited and hence they are not used routinely in clinical care. 81 CMR overcomes these limitations by measuring flow rate and vessel cross-sectional area independent of vessel location and geometry. In patients with an atrial septal defect, CMR measurement of Qp/Qs agreed well with estimation based on invasive oximetry (mean difference between techniques, 0.06 Qp/Qs units or 2.6%) and had low interobserver variability (Ͻ4%).…”

Section: Hemodynamic Evaluationmentioning

confidence: 99%