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Abnormal Doppler pulmonary venous flow patterns in children after repaired total anomalous pulmonary venous
L L Minich1, L Y Tani, J A Hawkins
1Department of Pediatrics, Primary Children's Medical Center, Salt Lake City, Utah 84113.
Insights
Children with repaired total anomalous pulmonary venous connection show altered pulmonary venous flow dynamics. Their flow shifts from ventricular systole to diastole, with increased reversed flow during atrial systole compared to healthy controls.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Physiology
- Echocardiography
Background:
- Total anomalous pulmonary venous connection (TAPVC) is a congenital heart defect requiring surgical repair.
- Post-repair pulmonary venous flow patterns are crucial for long-term outcomes.
- Doppler echocardiography is a non-invasive tool to assess cardiovascular hemodynamics.
Purpose of the Study:
- To evaluate and compare pulmonary venous flow patterns in children with repaired TAPVC versus healthy controls.
- To identify specific hemodynamic alterations in the pulmonary venous system after TAPVC repair.
Main Methods:
- Doppler echocardiography was utilized to assess pulmonary venous flow in 16 repaired TAPVC patients and 16 age-matched controls.
- Pulsed Doppler tracings of the right upper pulmonary vein were analyzed for peak velocities and velocity time integrals during different cardiac cycle phases.
- Mitral inflow indexes and cardiac outputs were also measured.
Main Results:
- Repaired TAPVC patients exhibited increased peak velocities during ventricular diastole and atrial systole compared to controls.
- Velocity time integrals were elevated during atrial systole but reduced during ventricular systole in repaired patients.
- Systolic-to-diastolic ratios for both peak velocity and velocity time integral were significantly decreased in the repaired group.
Conclusions:
- Normal pulmonary venous flow is predominantly during ventricular systole.
- Children with repaired TAPVC demonstrate a significant shift in pulmonary venous flow from ventricular systole to diastole.
- An increase in reversed flow during atrial systole is characteristic of the post-repair state in TAPVC.
Abstract:
Doppler echocardiography was used to evaluate pulmonary venous flow patterns in 16 children with repaired total anomalous pulmonary venous connection and in 16 age-matched normal controls. Using right upper pulmonary venous pulsed Doppler tracings, peak velocities and velocity time integrals were determined for ventricular systole, ventricular diastole, and atrial systole. Mitral inflow indexes and cardiac outputs were obtained. Patients with repaired total anomalous pulmonary venous connection and controls were similar in weight, heart rate, mitral inflow indexes, and cardiac output. In normal children, peak velocities were greater during ventricular diastole than systole, but velocity time integrals were greater during ventricular systole than diastole. Compared with normals, repaired patients had unobstructed flow patterns with increased peak velocities during ventricular diastole (0.92 +/- 0.35 vs 0.62 +/- 0.12 m/s) and atrial systole (0.27 +/- 0.12 vs 0.17 +/- 0.04 m/s). Velocity time integrals of repaired patients were increased during atrial systole (0.02 +/- 0.01 vs 0.01 +/- 0.03 m) but decreased during ventricular systole (0.08 +/- 0.03 vs 0.12 +/- 0.03 m). Systolic-to-diastolic ratios were decreased in repaired patients for peak velocity (0.56 +/- 0.20 vs 0.79 +/- 0.12) and velocity time integral (0.6 +/- 0.18 vs 1.48 +/- 0.35). Thus, pulmonary venous flow in normal children is greater during ventricular systole than during ventricular diastole. Repaired patients show a shift in forward flow from ventricular systole to diastole, with greater reversed flow during atrial systole.