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Doppler evaluation of aortic regurgitation in children
L Y Tani1, L L Minich, R W Day
1Department of Pediatrics, Primary Children's Medical Center, and the University of Utah, Salt Lake City 84113, USA.
Insights
Doppler echocardiography can accurately assess aortic regurgitation (AR) severity in children. Specific Doppler indexes, like jet width and flow reversal, show strong correlation with angiographic findings, potentially reducing the need for invasive angiography.
Area of Science:
- Pediatric Cardiology
- Diagnostic Imaging
- Echocardiography
Background:
- Aortic regurgitation (AR) severity assessment in children lacks systematic Doppler index evaluation.
- Established Doppler indexes for AR in adults have not been validated in pediatric populations.
Purpose of the Study:
- To evaluate the accuracy of Doppler echocardiographic indexes for assessing AR degree in children.
- To compare Doppler-derived measurements with angiographic grading of AR.
Main Methods:
- 30 children with suspected AR underwent 2D and Doppler echocardiography within 24 hours of angiography.
- Color Doppler parameters (jet width, area) and continuous-wave Doppler (AR slope) were measured.
- Pulsed Doppler assessed abdominal aortic flow, comparing indexes against angiographic AR severity groups.
Main Results:
- Color Doppler jet width and short-axis jet area strongly correlated with angiographic AR grade.
- Holodiastolic flow reversal in the abdominal aorta effectively distinguished moderate-to-severe AR (3+ to 4+) with 100% sensitivity.
- AR slope showed no correlation, while jet length and maximum jet area had limited group differentiation.
Conclusions:
- Color Doppler jet width, short-axis jet area, and holodiastolic abdominal aortic flow reversal are reliable predictors of AR severity in children.
- These Doppler indexes may serve as a non-invasive alternative to angiography for determining AR degree in pediatric patients.
Abstract:
Doppler indexes have been used successfully to determine the severity of aortic regurgitation (AR) in adults but have not been evaluated systematically in children. To evaluate the accuracy of specific Doppler echocardiographic indexes in assessing the degree of AR in children, 30 children underwent 2-dimensional and Doppler echocardiography within 24 hours of angiography. Patients were divided into 4 groups based on the degree of angiographic AR. Color Doppler jet width, short-axis jet area, jet length, and maximum jet area were measured. AR slope was measured using continuous-wave Doppler. Flow in the abdominal aorta was evaluated using pulsed Doppler. Doppler indexes were compared with the angiographic grade of AR. Jet width and short-axis jet area were significantly different between groups and showed strong correlation with the angiographic grade. Holodiastolic flow reversal in the abdominal aorta separated 1+ to 2+ from 3+ to 4+ AR (100% sensitivity and 100% negative predictive value for 3+ to 4+ AR). Jet length, maximum jet area, and the ratio of reverse to forward abdominal aortic velocity time integrals correlated with angiography but showed little difference between groups that differed by only 1 angiographic grade. AR slope did not correlate with the angiographic grade. We conclude that in children, color Doppler jet width, short-axis jet area, and holodiastolic abdominal aortic flow reversal are the best predictors of angiographic severity. Use of these indexes may obviate the need for angiography to determine the degree of AR in children.