Doppler pressure gradient estimation in children. Accuracy, effect of activity and exercise, and the need for...

Noninvasive estimation of pressure drop has been shown to be an accurate and useful application of Doppler echocardiography. Most accuracy series have used patient-sedated catheterization gradient measurements as the standard of reference. Doppler gradient estimates, however, are commonly made without sedation of the patient when hemodynamics may differ from those present at catheterization. We questioned whether "unsedated" Doppler gradient estimates would correlate in a useful way with "sedated" catheter measurements, Doppler gradient estimates would vary with patient activity, exercise or crying, and Doppler gradient estimates made using chloral hydrate sedation would prove useful in predicting sedated catheter measurements. Twenty-five infants and children were examined under conditions 1 and 2 above, and 20 under condition 3. Sedated Doppler estimates, performed at the time of catheterization corresponded closely with catheter measurements (r = 0.97, SEE = 4.8), confirming the accuracy of the Doppler method. Gradients estimated by Doppler without sedation, or with activity, correlated poorly with sedated catheter measurements (SEE = 16.2, SEE = 34.9, respectively). Use of chloral hydrate sedation for Doppler estimates resulted in good correlation with subsequent sedated catheter measurements. The results demonstrate marked increases in noninvasive Doppler pressure gradient estimates under conditions other than sedation. Clinicians tend to think in terms of sedated catheter gradients as the standard of reference for evaluation of severity and need for surgery. Ultrasonic data can only be used if Doppler estimates are performed under similar physiologic conditions; in children this requires sedation.