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Doppler systemic venous flow patterns: changes in children with mild/moderate pulmonic stenosis
L L Minich1, L Y Tani, R E Shaddy
1Department of Pediatrics, Primary Children's Medical Center, Salt Lake City, UT 84113, USA.
Insights
Systemic venous flow patterns, assessed via Doppler echocardiography, reveal early signs of right-sided heart dysfunction in children with pulmonic stenosis. These findings highlight venous flow as a sensitive indicator for right ventricular hypertension.
Area of Science:
- Pediatric Cardiology
- Echocardiography
- Hemodynamics
Background:
- Right ventricular hypertension can be challenging to detect early in pediatric patients.
- Pulmonic stenosis is a common cause of right ventricular pressure overload.
- Systemic venous flow patterns may reflect right heart function.
Purpose of the Study:
- To evaluate the utility of systemic venous flow patterns in identifying mild/moderate right ventricular hypertension in children.
- To compare venous flow characteristics between children with pulmonic stenosis and healthy controls.
Main Methods:
- Pulsed Doppler echocardiography was used to assess tricuspid valve, superior vena caval, and hepatic vein flow.
- Simultaneous respirometry and electrocardiography were employed.
- Measurements included peak velocities and velocity-time integrals during different cardiac phases.
Main Results:
- Patients with pulmonic stenosis showed altered respiratory variations in superior vena caval and hepatic vein flow compared to controls.
- Hepatic vein flow velocity-time integrals at ventricular end systole were significantly lower in patients.
- Hepatic vein flow velocity-time integrals at atrial systole were significantly higher in patients.
Conclusions:
- Abnormalities in systemic venous flow patterns are detectable in children with mild/moderate pulmonic stenosis.
- These venous flow changes may serve as a sensitive, non-invasive marker for early right-sided heart dysfunction.
- Doppler assessment of systemic venous flow can aid in the early diagnosis and management of pediatric right heart conditions.
Abstract:
To determine the usefulness of systemic venous flow patterns in patients with mild/moderate right ventricular hypertension, 17 patients with isolated mild/moderate pulmonic stenosis and 17 age-matched normal children were evaluated with pulsed Doppler echocardiography. Tricuspid valve, superior vena caval, and hepatic vein pulsed Doppler recordings were obtained with simultaneous respirometry and electrocardiography. Peak velocities and velocity-time integrals were measured for Doppler signals corresponding with ventricular systole, ventricular diastole, ventricular end systole, and atrial systole. The groups were similar in weight, heart rate, tricuspid inflow Doppler echocardiograms, and cardiac indexes. Compared with normal subjects, patients showed changes in respiratory variation for some superior vena caval and hepatic vein indexes. In addition, hepatic vein measurements made at ventricular end systole were significantly lower and measurements made at atrial systole were significantly higher in patients than in normal subjects. These changes in systemic venous flow patterns may provide a sensitive indicator of early right-sided heart dysfunction.