B. Stojnic et al., BIDIRECTIONAL SHUNT FLOW ACROSS A VENTRICULAR SEPTAL-DEFECT - PULSED DOPPLER-ECHOCARDIOGRAPHIC ANALYSIS, Pediatric cardiology, 16(1), 1995, pp. 6-11
Pulsed Doppler echocardiographic and hemodynamic examinations were per
formed in 31 patients (mean age 17.8 years) with isolated ventricular
septal defect (VSD). Three groups were studied: group I (n = 6) patien
ts had severe pulmonary vascular obstructive disease (PVOD); group II
(n = 12) patients had pulmonary hypertension (PH) without severe PVOD;
group III (n = 13) patients had no PH. Bidirectional shunting was det
ected in 9 VSD patients (6 in group I and 3 in group II). Patients wit
h low to moderately elevated right ventricular pressures demonstrated
left-to-right shunting across the defect throughout the cardiac cycle.
When systolic pressure in the right ventricle reached approximately 6
0% of the left ventricular pressure, right-to-left shunting occurred a
cross the defect during early and mid diastole. However, in patients w
ith Eisenmenger syndrome (group I) the right-to-left shunting occurred
during late systole with continuation during the early and mid diasto
lic period. The earlier occurrence of right-to-left shunting (index <
0.5 second) signifies the presence of severe PVOD.