RIGHT-VENTRICULAR PRESSURE ESTIMATION BY MEANS OF DOPPLER-ECHOCARDIOGRAPHY IN CHILDREN WITH VENTRICULAR SEPTAL-DEFECT

In order to evaluate the usefulness of Doppler echocardiographic study in decision making in children with ventricular septal defect (VSD), we examined our ability to estimate right ventricular pressure by comb ining 2-D echocardiography and Doppler studies. 31 infants and childre n (f = 14, m = 17) with ages between 1 month and 11 years [mean age: 3 0.26 +/- 40.33 months (SD)], the median was 12 months were examined pr ospectively. According to age, they were divided into two groups: Grou p A < 1 year (n = 17) and Group B > 1 year (n = 14). Echocardiographic and continuous wave Doppler (CW Doppler) examinations were performed one day before cardiac catheterization (cath). Associated cardiac anom alies were excluded. The blood pressure was measured by Dynamap and in older children by cuff. The systolic blood pressure (BP) value was as sumed equal to left ventricular systolic pressure. With pulse wave or CW Doppler the maximum flow velocity across the VSD was determined. Us ing the modified Bernouilli equation, the pressure difference between the left and right ventricle was calculated. Left ventricular (LVP), r ight ventricular (RVP) and pulmonary artery pressures were obtained at cardiac catheterization. The mean for estimated Doppler right ventric ular pressure (RVD) was 67.93 +/- 17.43 mmHg (SD) and for cath (RVP) 6 9.45 +/- 22.53 mmHg (SD). For the whole group (A + B) there was good p ositive correlation between Doppler RVD and cath RVP (r = 0.708; p < 0 .05). Furthermore there was a good positive correlation between the ra tio for RVD/BP and for RVP/LVP (r = 0.719; p < 0.001). The correlation between the estimated Doppler RVD and for cath RVP was for group A an d group B r = 0.416, n.s., and r = 0.896, p < 0.001. respectively. The lack of correlation in the smaller age group might possibly reflect t he difficulty in obtaining a reliable blood pressure measurement in in fancy. Our study shows that the combination of 2-D echo and CW Doppler echocardiography helps in decision making in children with VSD. This method should be used with more criticism in infants.