ABNORMAL DOPPLER PULMONARY VENOUS FLOW PATTERNS IN CHILDREN AFTER REPAIRED TOTAL ANOMALOUS PULMONARY VENOUS CONNECTION

Doppler echocardiography was used to evaluate pulmonary venous flow pa tterns in 16 children with repaired total anomalous pulmonary venous c onnection and in 16 age-matched normal controls. Using right upper pul monary venous pulsed Doppler tracings, peak velocities and velocity ti me integrals were determined for ventricular systole, ventricular dias tole, and atrial systole. Mitral inflow indexes and cardiac outputs we re obtained. Patients with repaired total anomalous pulmonary venous c onnection and controls were similar in weight, heart rate, mitral infl ow indexes, and cardiac output. In normal children, peak velocities we re greater during ventricular diastole than systole, but velocity time integrals were greater during ventricular systole than diastole. Comp ared with normals, repaired patients had unobstructed flow patterns wi th increased peak velocities during ventricular diastole (0.92 +/- 0.3 5 vs 0.62 +/- 0.12 m/s) and atrial systole (0.27 +/- 0.12 vs 0.17 +/- 0.04 m/s). Velocity time integrals of repaired patients were increased during atrial systole (0.02 +/- 0.01 vs 0.01 +/- 0.03 m) but. decreas ed during ventricular systole (0.08 +/- 0.03 vs 0.12 +/- 0.03 m). Syst olic-to-diastolic ratios were decreased in repaired patients for peak velocity (0.56 +/- 0.20 vs 0.79 +/- 0.12) and velocity time integral ( 0.6 +/- 0.18 vs 1.48 +/- 0.35). Thus, pulmonary venous flow in normal children is greater during ventricular systole than during ventricular diastole. Repaired patients show a shift in forward flow from ventric ular systole to diastole, with greater reversed flow during atrial sys tole.