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Doppler evaluation of superior caval venous pathways after Mustard and Senning operations
J M Parsons1, S A Qureshi, E J Ladusans
1Department of Paediatric Cardiology, Guy's Hospital, London, U.K.
Insights
Doppler ultrasound accurately assesses superior caval venous pathway patency after Mustard or Senning operations for complete transposition. Waveform patterns reliably distinguish between open and occluded pathways in pediatric cardiac surgery survivors.
Area of Science:
- Cardiology
- Pediatric Cardiac Surgery
- Vascular Ultrasound
Background:
- Complete transposition of the great arteries (TGA) often requires surgical correction.
- Venous redirection procedures like the Mustard and Senning operations are used to treat TGA.
- Assessing the long-term patency of superior caval venous pathways is crucial for patient outcomes.
Purpose of the Study:
- To evaluate the patency of superior caval venous pathways after Mustard and Senning operations using Doppler waveforms.
- To correlate Doppler findings with digital subtraction angiography (DSA) results.
- To determine if Doppler ultrasound is a reliable method for assessing venous pathway patency.
Main Methods:
- Analysis of Doppler waveforms from the superior caval vein in 26 survivors of Mustard or Senning operations.
- Correlation of Doppler findings with DSA performed within 24 hours.
- Classification of waveform patterns based on systolic and diastolic peaks.
Main Results:
- Digital subtraction angiography identified totally occluded pathways in 3 patients.
- Doppler waveforms showed a reversed pattern (systolic > diastolic peak) in occluded pathways.
- Patent pathways (23 patients) exhibited a characteristic waveform (systolic < diastolic peak).
Conclusions:
- Doppler examination of the superior caval vein is a quick and simple bedside method.
- This technique accurately determines the patency of superior caval venous pathways.
- It is a valuable tool for monitoring patients after atrial redirection procedures for TGA.
Abstract:
Doppler waveforms from the superior caval vein were analysed to evaluate the patency of superior caval venous pathways following venous redirection (Mustard and Senning) operations for complete transposition. The group consisted of 26 unselected survivors of Mustard (9 patients) and Senning operations (17 patients). Patients were examined a mean of 5.9 (range 0.1-15.3) years following operation and their age at study ranged from 0.4-25.3 years, mean 7.3 years. Doppler waveforms were correlated with digital subtraction angiograms, which were performed in every patient within 24 hours of the Doppler study. Totally occluded superior caval venous pathways were identified in 3 patients with digital subtraction angiography. The remaining patients had angiographically patent pathways. In the 23 patients with patent pathways, Doppler waveforms demonstrated an initial systolic peak smaller than a second diastolic peak. In the 3 patients with totally occluded pathways, the pattern of the waveform was reversed, with the systolic larger than the diastolic peak. Doppler examination of the superior caval vein is a quick and simple bedside method of accurately determining patency of superior caval venous pathways after atrial redirection procedures for complete transposition.