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Doppler assessment of interventricular pressure gradient across isolated ventricular septal defect
A Garg1, S Shrivastava, S Radhakrishnan
1Department of Cardiology, All India Institute of Medical Sciences, New Delhi.
Insights
Continuous wave Doppler ultrasound accurately estimates the pressure gradient across ventricular septal defects (VSDs). This noninvasive method aids in assessing pulmonary artery systolic pressure in VSD patients.
Area of Science:
- Cardiology
- Medical Imaging
- Pediatric Cardiology
Background:
- Isolated ventricular septal defect (VSD) requires accurate assessment of pulmonary artery systolic pressure.
- Cardiac catheterization is an invasive method for pressure gradient measurement.
- Noninvasive alternatives are sought for VSD management.
Purpose of the Study:
- To evaluate the accuracy of continuous wave Doppler ultrasound in estimating the pressure gradient across VSDs.
- To compare Doppler-derived pressure gradients with cardiac catheterization data.
- To assess the utility of Doppler ultrasound for pulmonary artery systolic pressure estimation in VSD patients.
Main Methods:
- Continuous wave Doppler ultrasound was used to measure the interventricular pressure gradient in 30 VSD patients.
- Doppler measurements were performed within 24 hours of cardiac catheterization.
- Correlation analysis was performed between Doppler and catheterization data.
Main Results:
- Doppler-derived pressure gradients (8-78 mmHg) showed excellent correlation with cardiac catheterization (7-95 mmHg), with r=0.90 (p<0.001).
- Correlation was stronger (r=0.96) in patients with gradients <75 mmHg.
- Poorer correlation was observed in a few cases with very small VSDs and high gradients due to suboptimal jet visualization.
Conclusions:
- Continuous wave Doppler ultrasound is an accurate, noninvasive tool for measuring pressure gradients across VSDs.
- This technique is valuable for assessing pulmonary artery systolic pressure in VSD patients without outflow tract obstruction.
- Doppler ultrasound offers a reliable alternative to invasive methods for VSD hemodynamic assessment.
Abstract:
Continuous wave Doppler ultrasound was used to estimate the pressure gradient between the right and left ventricle for assessment of pulmonary arterial systolic pressure in 30 patients with isolated ventricular septal defect and for subsequent comparison with similar data obtained on cardiac catheterization. The age of the patients ranged from 8 months to 45 years (6.8 +/- 8.6 years). No patient had right or left ventricular outflow tract obstruction. Doppler measurements were done within 24 h of cardiac catheterization. Pressure gradient across ventricular septal defect on cardiac catheterization ranged from 7 to 95 mmHg (48 +/- 24 mmHg) and that on Doppler assessment ranged from 8 to 78 mmHg (42 +/- 20 mmHg). Doppler measurements of interventricular pressure gradient correlated well with those obtained on cardiac catheterization (r = 0.90, p less than 0.001). Correlation was better in patients with pressure gradient across ventricular septal defect less than 75 mmHg (r = 0.96). Correlation was poor in three of five patients with very small ventricular septal defects (interventricular pressure gradient greater than 75 mmHg) because the jet used was not ideal. Thus continuous wave Doppler ultrasound is an accurate noninvasive means of measuring pressure gradient across ventricular septal defect, which is a useful parameter for assessment of pulmonary artery systolic pressure in patients with isolated ventricular septal defect without right and left ventricular outflow tract obstruction.