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Continuous Venous-Arterial Doppler Ultrasound During a Preload Challenge
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Consistency of the continuous flow pressure gradient despite aortic arch anomalies co-existing with coarctation

Arash Ghorbannia1,2, Andrew D Spearman2, Shahd Sawalhi1

  • 1Department of Biomedical Engineering, Marquette University and the Medical College of Wisconsin, Milwaukee, Wisconsin, USA.

Medrxiv : the Preprint Server for Health Sciences
|November 14, 2023
PubMed

Insights

Continuous flow pressure gradient (CFPG) offers improved severity assessment for coarctation of the aorta (CoA), even in complex cases with aortic arch anomalies. This method is more reliable than conventional Doppler indices for diagnosing coarctation of the aorta.

Area of Science:

  • Cardiovascular Medicine
  • Medical Imaging
  • Hemodynamics

Background:

  • Coarctation of the aorta (CoA) severity assessment is challenging, particularly in complex cases with anatomical variations and reliance on Doppler-derived indices.
  • Conventional Doppler indices often yield inaccurate pressure gradients, complicating clinical decisions.

Approach:

  • This study retrospectively analyzed patients with discrete and complex CoA, comparing blood pressure gradients (BPG) derived from continuous flow pressure gradient (CFPG) with conventional Doppler methods.
  • Computational simulations using a preclinical CoA model were employed to understand the performance differences between CFPG and conventional indices, especially concerning aortic arch hypoplasia.

Key Points:

  • Diagnostic performance of conventional Doppler indices significantly decreased in complex CoA cases.
  • Continuous flow pressure gradient (CFPG) showed only a modest reduction in diagnostic indicators for complex CoA compared to discrete CoA.
  • Simulations highlighted that the inclusion of specific Doppler parameters influences CFPG performance.

Conclusions:

  • Continuous flow pressure gradient (CFPG) is less impacted by aortic arch anomalies associated with coarctation of the aorta (CoA) than conventional Doppler indices.
  • CFPG presents a more robust option for assessing CoA severity in the presence of complex anatomical variations.
  • This finding supports the clinical utility of CFPG in challenging coarctation of the aorta diagnoses.
Abstract

Keywords:
Antegrade diastolic flowDiastolic runoffEchocardiographyHypoplastic Aortic ArchLong Segment Coarctationhypertensionsimulation

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