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[Doppler echocardiography assessment of hemodynamic values and additional heart defects in atrial septal defects]
T Rupprecht1, T Seiler, M Hofbeck
1Kardiologische Abteilung, Universität Erlangen-Nürnberg.
Insights
Echocardiography can estimate atrial septal defect size, but associated anomalies may be missed. A new nomogram correlating defect size with hemodynamic parameters helps identify complex cases needing further evaluation.
Area of Science:
- Cardiovascular Medicine
- Pediatric Cardiology
- Medical Imaging
Background:
- Transthoracic echocardiography (TTE) has advanced, questioning the necessity of cardiac catheterization for atrial septal defects (ASDs).
- While TTE estimates shunt magnitude and ASD size, it may not detect associated anomalies like anomalous pulmonary venous connections.
- Cardiac catheterization remains a diagnostic tool for complex congenital heart disease.
Purpose of the Study:
- To evaluate the correlation between echocardiographically determined ASD anatomical size and hemodynamic parameters.
- To develop a nomogram to aid in identifying associated cardiovascular malformations in pediatric patients with ASDs.
- To assess the utility of this nomogram in detecting complex defects.
Main Methods:
- Echocardiographic measurement of ASD anatomical size in 25 children.
- Calculation of hemodynamic parameters: pulmonary-to-systemic flow ratio (Qp/Qs) and pulmonary-to-systemic vascular resistance ratio (Rp/Rs).
- Derivation of effective defect resistance (Rd/Rs) and development of a nomogram relating defect size to hemodynamic parameters.
Main Results:
- A significant non-linear correlation was found between Rd/Rs and the anatomical size of the ASD.
- The developed nomogram effectively described the relationship between ASD size and hemodynamic parameters.
- The nomogram correctly identified a cohort of four patients with associated defects, including anomalous pulmonary venous connections.
Conclusions:
- The developed nomogram serves as a valuable tool for identifying potential associated cardiovascular malformations in pediatric ASD patients.
- This approach can guide further diagnostic evaluation, potentially reducing the need for invasive procedures in uncomplicated cases.
- The nomogram enhances diagnostic accuracy for complex congenital heart disease involving ASDs.
Abstract:
Due to the rapid progress in (Doppler-) echocardiography "one must question whether cardiac catheterisation remains a necessary prelude to cardiac surgery in atrial septal defects" (8). Although the estimation of the magnitude of the intracardiac shunt and the anatomical size of the defect ist possible by (Doppler-) echocardiography there remains the problem of associated disorders (e.g. anomalies of the pulmonary venous connection) which may not be detected by transthoracic echocardiography. In 25 children submitted to cardiac catheterisation studies in the period between 1990 and 1992, the anatomical size of an atrial septal defect was measured echocardiographically. The haemodynamic parameters Qp/Qs and Rp/Rs were employed to calculate the so-called effective resistance of the defect (Rd/Rs), which was derived from an electrical analogue and represents the ratio of the resistance of the defect (Rd) to the systemic vascular resistance (Rs). The echocardiographically measured anatomical size (expressed as the ratio of the area of the defect to the cross-sectional area of the ascending aorta) was related to the effective resistance of the defect. A significant (non-linear) correlation was found between Rd/Rs and the anatomical size of defect. Based on these data we developed a nomogram describing the relationship of the size of the defect to the haemodynamic parameters (Qp/Qs and Rp/Rs). If the data of a patient do not comply with this nomogram there is strong evidence of an additional cardiovascular malformation, necessitating further evaluation. A second cohort of four patients with associated defects (partial and total anomalous pulmonary venous connection and a corresponding sinus venosus defect) was clearly identified by the nomogram method.