Related Experiment Video
Updated: Apr 15, 2026
Hemodynamic Precision in the Neonatal Intensive Care Unit using Targeted Neonatal Echocardiography
Published on: January 27, 2023
Doppler-derived flow pattern in the descending aorta does not predict systemic to pulmonary arterial collateral flow
Michael V Di Maria1, Meryl S Cohen2, Matthew A Harris2
1Children's Hospital Colorado Heart Institute, University of Colorado School of Medicine, Aurora, CO, USA michael.dimaria@childrenscolorado.org.
Insights
Doppler echocardiography VTI ratio does not accurately estimate collateral flow in single ventricle patients after cavopulmonary anastomosis. Cardiac MRI measurements showed a weak correlation, indicating limitations in Doppler assessment for these complex pediatric heart conditions.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease
- Cardiac Imaging
Background:
- Children with single ventricle heart disease risk systemic to pulmonary arterial collateral vessels.
- Collateral flow (CollF) impacts short-term outcomes, but long-term effects are unclear.
- Cardiac magnetic resonance (CMR) quantifies CollF; Doppler VTI has been used for 'runoff' lesions.
Purpose of the Study:
- To test if the velocity-time integral (VTI) ratio in the descending aorta (DAo) after cavopulmonary anastomosis (CPA) estimates collateral flow (CollF).
- To compare Doppler-derived VTI ratio with CMR-derived flow ratios for CollF estimation.
Main Methods:
- Retrospective cross-sectional study of pediatric patients post-CPA undergoing CMR.
- VTI ratio analyzed from DAo spectral Doppler tracings in 88 patients.
- CMR quantified retrograde to antegrade DAo flow ratio in 112 patients.
Main Results:
- No linear correlation found between Doppler VTI ratio and CollF (r² = .006, P = .46).
- CMR-derived retrograde/antegrade flow ratio showed weak positive correlation with CollF (r² = .07, P = .007).
- Holodiastolic flow reversal by CMR predicted significantly higher CollF (P = .04), but not by echo (P = .40).
Conclusions:
- Doppler echo VTI ratio is inaccurate for reflecting CollF in single ventricle children post-CPA.
- CMR-derived flow assessment shows some correlation, suggesting its potential utility.
- Further research may be needed to refine non-invasive CollF quantification methods.
Background:
Children with single ventricle heart disease are at risk for developing systemic to pulmonary arterial collateral vessels that adversely impact short-term outcomes, although the effect on long-term outcomes remains unclear. Collateral flow (CollF) can be quantified using cardiac magnetic resonance (CMR) flow quantification. The velocity-time integral (VTI), obtained from spectral Doppler tracings, has been used in "runoff" lesions like aortic regurgitation to quantify insufficiency. We hypothesized that the VTI ratio of the proximal descending aorta (DAo) after cavopulmonary anastomosis (CPA) would estimate CollF.
Methods:
A retrospective cross-sectional study was conducted. Patients who had a superior CPA or total CPA and underwent CMR between April 2008 and December 2012 were included. Those with greater than trivial semilunar valve insufficiency or aortic arch obstruction were excluded. In a subset (n = 88), spectral Doppler tracings of the DAo were analyzed to determine the VTI ratio. In another subset (n = 112), CMR was used to determine the ratio of retrograde to antegrade flow in the DAo.
Results:
There was no linear correlation between VTI ratio and CollF (r (2) = .006, P = .46). There was a weakly positive correlation with CollF (r (2) = .07, P = .007) and the CMR measured ratio of retrograde to antegrade flow. Holodiastolic flow reversal by echo did not predict higher CollF (P = .40), but those with holodiastolic flow reversal by CMR had significantly higher CollF (P = .04).
Conclusions:
The ratio of reverse to forward flow in the DAo as determined by Doppler echo does not accurately reflect CollF in children with single ventricle after CPA.
More Related Videos
08:21Functional Assessment of the Donor Heart During Ex Situ Perfusion: Insights from Pressure-Volume Loops and Surface Echocardiography
Published on: October 11, 2022
09:23Shunt Surgery, Right Heart Catheterization, and Vascular Morphometry in a Rat Model for Flow-induced Pulmonary Arterial Hypertension
Published on: February 11, 2017
