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An evaluation of the left atrial/aortic root ratio in children with ventricular septal defect
Insights
The echocardiographic left atrial-to-aortic root ratio (LA/Ao) poorly correlates with pulmonary-to-systemic flow (Qp/Qs) in children with ventricular septal defect (VSD). This ratio cannot reliably estimate shunt severity in VSD patients.
Area of Science:
- Pediatric Cardiology
- Diagnostic Imaging
- Congenital Heart Disease
Background:
- Ventricular septal defect (VSD) is a common congenital heart anomaly.
- Accurate assessment of shunt severity is crucial for VSD management.
- Echocardiography is a primary non-invasive tool for VSD evaluation.
Purpose of the Study:
- To evaluate the reliability of the echocardiographic left atrial-to-aortic root diameter ratio (LA/Ao) in estimating pulmonary-to-systemic flow ratio (Qp/Qs) in infants and children with isolated VSD.
- To compare echocardiographic measurements with angiographic data, assessing the impact of transducer angulation.
Main Methods:
- Echocardiograms and cardiac catheterization were performed in 80 pediatric VSD patients.
- The LA/Ao ratio was correlated with the Qp/Qs.
- Left atrial and aortic root dimensions were compared between echocardiography and lateral cineangiography in 55 patients, with varying transducer angles.
Main Results:
- A poor correlation (r = 0.62) was found between the echocardiographic LA/Ao ratio and Qp/Qs.
- Echocardiographic and angiographic aortic root measurements were comparable (r = 0.95).
- Angiographic left atrial dimensions were significantly affected by transducer beam angulation, unlike aortic root measurements.
Conclusions:
- The echocardiographic LA/Ao ratio is not a reliable method for estimating shunt severity in VSD.
- Transducer angulation can significantly influence left atrial measurements, impacting diagnostic accuracy.
- Alternative methods may be necessary for precise shunt quantification in pediatric VSD.
Abstract:
Echocardiograms were performed in 80 infants and children with isolated ventricular septal defect (VSD) who underwent cardiac catheterization. The pulmonary-to-systemic flow ratio (Qp/Qs) was correlated with the echocardiographic left atrial-to-aortic root diameter ratio (LA/Ao), and a relatively poor correlation (r = 0.62) was found. The end-systolic diameters of the left atrium and aorta at the level of the aortic root, obtained from lateral cineangiograms of 55 of the 80 patients, were compared with the corresponding echocardiographic dimensions. To assess the possible effect of transducer beam angulation upon the echocardiographic determinations, the angiographic measurements were made at 0 degrees position (perpendicular to the frontal plane) and at angles of 5 degrees, 10 degrees, 15 degrees and 20 degrees from zero, using the aortic root center as the point of intersection. The echocardiographic and angiographic aortic root measurements were comparable (r = 0.95), and the angiographically derived aortic diameter did not vary with different angle projections. However, the left atrial angiographic dimensions were significantly influenced by the angle of projection. We conclude that the echocardiographic LA/Ao ratio cannot reliably estimate the severity of the shunt flow in VSD.