Reduction of carotid arterial blood flow in ventricular septal defect associated with severe congestive heart failure

After diagnosing abnormality of cardiac and carotid-cerebral circulation in an infant with isolated ventricular septal defect (VSD) associated with severe congestive heart failure, the authors measured the carotid arterial blood flow volume (CABF). At 3 months, the patient was not thriving and had dyspnea because of severe congestive heart failure. The authors measured the VSD size/body surface area (BSA) ratio relative to the predicted value of the left ventricular end-diastolic dimension (%LVEDd), left-to-right shunt ratio (Qp/Qs), and the small stroke volume (SV)/BSA using echocardiography and cardiac catheterization. The mean, maximum, and minimum CABF (mean CABF, maxCABF, and minCABF) among R-R intervals on electrocardiogram were measured by Doppler flowmetry in this patient and 5 healthy age-matched control children. The patient had a large VSD size/BSA ratio (37.9 mm/m2), %LVEDd (164%), and Qp/Qs (3.8), and a small SV/BSA ratio (18 mL/m2). The mean CABF, maxCABF, and minCABF were significantly lower than those of control children (VSD patient vs. controls; 2.7 +/- 0.4 vs. 4.5 +/- 0.6, 6.1 +/- 0.9 vs. 12.0 +/- 2.1, 1.2 +/- 0.2 vs. 1.7 +/- 0.4 mL/sec (mean +/- S.D.)), respectively (p < 0.01). The authors' results showed abnormal cardiac and carotid-cerebral circulation in an infant with large VSD associated with severe congestive heart failure.