Cerebral blood flow velocity during occlusive manipulation of patent ductus arteriosus in children

Patent ductus arteriosus (PDA) with left-to-right shunting modifies the Dop pler low pattern of the intracranial circulation. The ability of increases in cerebral blood flow velocity (CBFV) to predict shunt resolution during P DA occlusion was evaluated. A 2 MHz transcranial Doppler (TCD) monitored di astolic and mean CBN, plus the systolic/mean CBFV ratio in the middle cereb ral artery from before (baseline) to immediately after PDA occlusion. Shunt resolution was verified by echocardiography and/or angiography. A Minimum of 40% increase in diastolic-CBFV from baseline was considered successful r esolution. Patients were age-stratified into group I (<15 months; n=23) and group II (>15 months; n=10). Thirty-three children were studied (age, 0.1 to 109 months) during surgical (n=22) or coil occlusions (n=11). Transcrani al Doppler successfully identified shunt resolution in 78% of cases in grou p I, as compared to 0% in group II (p<0.01). Identification rate decreased from 79% in cases of minimum ductal diameter of 3 mm (n=19) to 21% in small er ductuses (n=14) (p<0.01). Body weight and left-atrium size (p=0.004) in group I and PDA diameter in group II (p=0.02), were the only preoperative d uctal parameters associated with diastolic-CBFV changes after ductus occlus ion. Transcranial Doppler detects shunt resolution in infants with moderate to large PDAs.