The Noninvasive Evaluation of Hemodynamics in Congenital Heart Disease
The noninvasive evaluation of hemodynamics in congenital heart disease is an application for which Doppler ultrasound is ideally suited. The pediatric cardiac sonographer has used 2D and TM imaging for several years to study the structural abnormalities a
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Developments in Cardiovascular Medicine VOLUME 114
The titles published in this series are listed at the end ofthis volume.
THE NONINVASIVE EVALUATION OF HEMODYNAMICS IN CONGENITAL HEART DISEASE Doppler Ultrasound Applications in the Adult and Pediatric Patient with Congenital Heart Disease
Edited by
JAMES V. CHAPMAN Scientific Research Coordinator in Clinical Ultrasound, Department oj Cardiology, University Medical Center, Gent, Belgium
and GEORGE R. SUTHERLAND Director oj Echocardiography Laboratory, Department ojCardiology, Thorax Center, Erasmus University, Rotterdam, The Netherlands
KLUWER ACADEMIC PUBLISHERS DORDRECHT / BOSTON / LONDON
Library of Congress Cataloging-in-Publication Data The Noninvasive evaluation of hemodynamics in congenital heart disease Doppler ultrasound applications in the adult and pediatric patient with congenital heart disease I [edited by] James V. Chapman. George R. Sutherland. p. em. -- F
49.996
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Fig. 5-3. In this series of I4 consecutive patients with valvular aortic stenosis, the invasively and noninvasively obtained gradients were in close agreement (r=.89).
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Doppler Data File: Source
PS Sum of
Squares
oeg. of Freedom
Model
33084. 725
Error
2155.275
30
35210.000
31
Total
Mean Squares
33054.725
Coefficient of Determination (R"'2) Adjusted Coefficient (A"2) Coefficient of Correlation (R) Standard Error of Estimate Durbin-Watson Statistic
F-Ratio
Prob>F
460.106
0.060
71.843
0.939 0.937 0.969 8.476 1.822
Fig. 5-4. In rhe setting ofpulmonary stenosis, a very good correlation between catheterization and Doppler derived gradients was obtained (r=.97).
Obstructive Lesions in Congenital Heart Disease
95
Fig. 5-5. In this patient with mild pulmonary stenosis, the peakflow velocity across the valve is 2.6 mis, yielding a peak outflow gradient of27 mm Hg. The peak infundibular gradient is 21 mm Hg, indicating that the transvalvular gradient is 6 mm Hg. This study was obtained from the parasternal transducer position (inset). The infundibular (top) and valvular (bottom) flow velocity traces are demonstrated. The infundibular flow was recorded with pulsed Doppler, while the outflow was recorded with high pulse repetition frequency (HPRF) mode. To calculate the actual valvular gradient, flow velocities need to be sampledfrom localized regions in the flow circuit. Both conventional pulsed mode and HPRF mode offer range resolution; HPRF mode permits the measurement ofrelatively high velocities.
Fig. 5-6. The spectral analysis-derived peak and mean velocity analog curves are demonstrated. The peak flow velocity is 3.0 mis, and has a weaker signal strength than the mean velocity of approximately 1.3 mls. In a disturbed flow, the mean and peak velocities may be markedly different in value and signal strength. If the Doppler system employed does not have a high degree of sensitivity, the signals in the high velocity range
