Author + information
- G. Wesley Vick III, MD, PhD1,
- Daniel J. Murphy Jr., MD*,1,
- Achi Ludomirsky, MD1,
- W. Robert Morrow, MD1,
- Mary J.H. Morriss, MD, FACC1,
- David A. Danford, MD1 and
- James C. Huhta, MD, FACC1,2
- ↵*Address for reprints: Daniel J. Murphy, Jr., MD, Pediatric Cardiology, Texas Children's Hospital, 6621 Fannin Street, Houston, Texas 77030.
Obstruction to pulmonary venous return may be associated with a number of congenital cardiovascular abnormalities occurring both before and after surgery. Hemodynamic assessment by cardiac catheterization is often difficult. A noninvasive method for detection and quantitation of obstruction to systemic ventricular inflow would be clinically useful. Two-dimensionally directed pulsed and continuous wave Doppler echocardiography was performed before cardiac catheterization in 31 patients thought clinically to have possible obstruction to left ventricular inflow or pulmonary venous return. Primary diagnoses included transposition of the great arteries after the Mustard or Senning procedure in nine patients, total anomalous pulmonary venous connection in nine (in two after surgical repair), cor triatriatum in eight (in four after surgical repair), congenital mitral stenosis in four (in one after surgical repair) and mitral atresia in one. Severe obstruction was defined as a mean pressure gradient at catheterization of ≥16 mm Hg at any level of the pulmonary venous return or of the systemic ventricular inflow. Severe obstruction was predicted if Doppler examination measured a flow velocity of ≥2 m/s across any area of inflow obstruction.
At catheterization, 12 patients (39%) had severe obstruction to left ventricular inflow or pulmonary venous return and all obstructions were correctly detected by Doppler echocardiography. The site of pulmonary venous obstruction was localized by two-dimensionally directed pulsed Doppler study. Patients with a lesser degree of obstruction had a lower Doppler velocity, but none had a maximal Doppler velocity of ≥2 ms/s. These results suggest that two-dimensionally directed pulsed and continuous wave Doppler studies are accurate in detecting severe obstruction to pulmonary venous return in children with congenital heart disease. Doppler techniques should be useful in the selection of patients for cardiac catheterization, particularly when obstruction to pulmonary venous return is suspected postoperatively.
- American College of Cardiology Foundation