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Intracardiac shunting in children with ventricular septal defect: evaluation with Doppler color flow mapping
R J Sommer1, R J Golinko, S B Ritter
1Division of Pediatric Cardiology, Mount Sinai Medical Center, New York, New York 10029.
Insights
Two-dimensional Doppler echocardiography reveals complex, bidirectional blood flow across ventricular septal defects in children. This noninvasive method highlights differences in flow patterns based on defect type and ventricular volume overload.
Area of Science:
- Pediatric Cardiology
- Echocardiography
- Congenital Heart Disease
Background:
- Ventricular septal defects (VSDs) are common congenital heart abnormalities.
- Angiography previously showed bidirectional transseptal blood flow in VSDs, but noninvasive methods were needed.
Purpose of the Study:
- To investigate intracardiac blood flow patterns in children with VSDs noninvasively.
- To characterize flow dynamics during different cardiac cycle phases using echocardiography.
Main Methods:
- Seventy-seven children (1 day to 15.5 years) with VSDs underwent two-dimensional Doppler color flow echocardiography.
- Blood flow across the ventricular septum was analyzed during isovolumetric contraction, isovolumetric relaxation, and diastole.
Main Results:
- Left-to-right flow was observed during isovolumetric contraction in 98% of studies.
- Right-to-left flow was noted during isovolumetric relaxation in 96% of studies.
- Diastolic flow patterns differed significantly between isolated VSDs and those with right ventricular volume overload (p=0.0001).
Conclusions:
- Echocardiography confirms complex intracardiac shunting in pediatric VSDs.
- Findings suggest intrinsic functional differences between morphologic left and right ventricles.
- Diastolic flow patterns vary significantly with VSD complexity and associated conditions.
Abstract:
In children with a ventricular septal defect, transseptal blood flow has been demonstrated angiographically to be bidirectional in all but the smallest defects. To investigate this phenomenon noninvasively, two-dimensional Doppler color flow echocardiography was used in 77 patients (aged 1 day to 15.5 years, mean 24 months). During isovolumetric contraction, flow was seen from the left to the right ventricle in 82 (98%) of 84 studies. During isovolumetric relaxation, right to left flow was noted in 72 (96%) of 75 studies. During early diastole in patients with an isolated defect, flow was initially from the right to the left ventricle and subsequently reversed to become left to right in 29 (91%) of 32 studies. In patients with concomitant right ventricular volume overload, flow across the ventricular defect was from the right to the left ventricle throughout diastole in 30 (86%) of 35 studies. In each of four patients with d-transposition of the great vessels and each of two patients with 1-transposition of the great vessels, blood flow was from the morphologic left ventricle to the morphologic right ventricle during isovolumetric contraction and from the morphologic right ventricle to the morphologic left ventricle during isovolumetric relaxation. These results demonstrate 1) the complex nature of intracardiac shunting in children with ventricular septal defect as previously shown by angiography; 2) an intrinsic functional difference in the contractile and relaxation properties of the morphologic left and right ventricles; and 3) differences in diastolic blood flow patterns between children with an isolated defect and those with a ventricular septal defect and right ventricular volume overload (p = 0.0001).