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Echocardiographic estimation of a left-to-right shunt in isolated ventricular septal defects
Insights
Echocardiography effectively estimates pulmonary-to-systemic flow (Qp:Qs) in infants and children with ventricular septal defects (VSDs). Key echocardiographic ratios, like LA:Ao, correlate with Qp:Qs, aiding noninvasive VSD assessment.
Area of Science:
- Pediatric Cardiology
- Diagnostic Imaging
- Congenital Heart Disease
Background:
- Ventricular septal defects (VSDs) are common congenital heart abnormalities.
- Accurate assessment of pulmonary-to-systemic flow (Qp:Qs) is crucial for managing VSDs.
- Noninvasive methods to estimate Qp:Qs are highly desirable.
Purpose of the Study:
- To evaluate the utility of echocardiography in estimating the Qp:Qs ratio in infants and children with isolated VSDs.
- To compare echocardiographic measurements with invasive Qp:Qs determination.
- To identify echocardiographic parameters that correlate with Qp:Qs.
Main Methods:
- Echocardiographic examination of 35 infants and children with VSDs within 24 hours of cardiac catheterization.
- Measurement of left atrial to aortic root (LA:Ao) ratio, LA internal dimension/m2 body surface area (LAID/m2), and LV internal dimension in diastole/m2 body surface area (LVIDd/m2).
- Comparison of echocardiographic data with Qp:Qs ratios obtained from cardiac catheterization; 35 healthy children served as controls.
Main Results:
- The LA:Ao ratio was significantly higher in the VSD group (1.38 ± 0.13) compared to controls (1.01 ± 0.05) (P<0.01).
- LAID/m2 and LVIDd/m2 were also significantly elevated in VSD patients versus controls (P<0.01).
- Echocardiographic dimensions demonstrated a strong positive correlation with increasing Qp:Qs ratios (r=0.71–0.73); LA:Ao ratios >1.4:1 generally indicated Qp:Qs >2:1.
Conclusions:
- Echocardiography is a valuable noninvasive tool for estimating Qp:Qs in isolated VSDs.
- Echocardiographic parameters, particularly the LA:Ao ratio, can serve as additional clinical indicators for assessing VSD severity.
- These findings support the use of echocardiography as a primary diagnostic method, potentially reducing the need for invasive procedures.
Abstract:
35 infants and children with isolated ventricular septal defects (VSDs) had echocardiographic examination within 24 h of cardiac catheterization. Left atrial to aortic root (LA : Ao) ratio, left atrial internal dimension/meter square body surface area (LAID/m2) and left ventricular internal dimension in diastole/meter square body surface area (LVIDd/m2) were compared with the cardiac catheterization determined pulmonary-to-systemic flow (Qp : Qs) ratio. 35 children with normal cardiovascular findings served as controls. The LA : Ao ratio in the VSD group (1.38 +/- 0.13) was significantly higher than in the control group (1.01 +/- 0.05) (P less than 0.01). Similarly the LAID/m2 and LVIDd/m2 were significantly higher in the VSD group than in the control group (P less than 0.01). Additionally, echographic dimensions were increased in proportion to the elevation of Qp : Qs (r = 0.71--0.73). LA : Ao ratios higher than 1.4 : 1 were generally associated with Qp : Qs ratios greater than 2 : 1. All patients with Qp : Qs greater than 2 : 1 had LA : Ao ratios of 1.4 or higher. This study suggested that echocardiography is a useful noninvasive technique in estimating the Qp : Qs in patients with isolated VSDs, and may serve as an additional clinical parameter in the assessment of patients with VSDs.