Peripheral arterial contrast echocardiography: A new method for the detection of left‐to‐right shunting patent ductus arteriosus

Saline contrast echocardiography was performed in 889 children from June 1976 through February 1988. One-third of these studies were in postoperative patients. A patent foramen ovale was identified by finding right to left shunting on venous contrast injection in 37% of 127 children studied with a structurally normal heart. The incidence of such shunting was greater at younger ages (55% younger than 1 month versus 22% older than 1 month). In most patients with an atrial or ventricular septal defect, some right to left shunting was demonstrable. The technique was useful in distinguishing different forms of atrial septal defect and identifying muscular ventricular septal defects that were difficult to image directly. The technique was used in the catheterization laboratory to aid in the identification of congenital coronary artery fistulas and was diagnostic in two cases of pulmonary arteriovenous malformation. In patients with situs abnormalities, the technique was useful in identifying the systemic venous connections to the atria. Contrast echocardiography was also used in postoperative evaluations. The technique was useful in identifying patch leaks and residual defects after Senning, Mustard and Fontan operations, and after closure of atrial and ventricular septal defects. Most patients were found to have no superior vena cava obstruction by contrast echocardiography after the Senning or Mustard procedure. Contrast echocardiography continues to be a useful technique in the diagnosis of a wide spectrum of congenital heart disease, as well as in the postoperative evaluation of congenital heart surgery.

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Noninvasive Doppler echocardiographic evaluation of shunt flow dynamics of the ductus arteriosus.

Hiraishi¹,

Horiguchi²,

Misawa³

et al. 1987

Circulation

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The pulsed Doppler technique was used to record the flow velocity patterns in the ductus arteriosus and the pulmonary artery in 26 patients with either isolated or complicated patent ductus arteriosus (PDA). In all patients, abnormal Doppler signals indicating left-to-right (L-R) or right-to-left shunt flow or both could be obtained at the site of the ductus arteriosus. These Doppler flow patterns determined within the ductus coincided with the direction of ductal flow seen on the contrast two-dimensional echocardiogram. No Doppler signals of shunt flow were demonstrated in any of 42 control subjects. The peak, mean, and diastolic velocities of the L-R shunt flow within the ductus were measured from the ductal flow velocity profiles. With the Doppler-derived measurements of the mean and diastolic velocities, patients with normal pulmonary arterial pressure and those with evidence of pulmonary hypertension could be correctly identified. In addition, the mean velocity of the diastolic antegrade flow portion obtained from the proximal left pulmonary artery, which was related to ductal L-R shunting, was measured in 16 patients with isolated PDA. This Doppler flow determinant showed a good linear correlation with the L-R shunt ratio determined by Fick's method (r = .88, p < .01). Our technique permits the noninvasive evaluation of shunt flow dynamics in patients with PDA. Circulation 75, No. 6, 1146-1153, 1987 ALTERATION of Doppler flow patterns in the pulmonary artery and descending aorta has been useful in the diagnosis of patent ductus arteriosus (PDA).1 Twodimensional echocardiography has allowed visualization of the ductus from the parasternal, suprasternal, and subxyphoid windows.6'7 Recent reports8'9 have demonstrated that two-dimensional/Doppler echocardiography is a highly sensitive technique for detection of ductal patency. However, few studies have been reported concerning the assessment of shunt flow within the ductus.°l We therefore designed the present study to (1) evaluate the ability of two-dimensional/ Doppler echocardiography to determine the direction of shunt flow in the ductus and (2) assess the pulmonary-to-systemic peak pressure ratio and the degree of left-to-right (L-R) shunting with Doppler-derived indexes of the flow velocity.

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Peripheral arterial contrast echocardiography: A new method for the detection of left‐to‐right shunting patent ductus arteriosus

Cited by 3 publications

References 20 publications

Semilunar Valves/Great Arteries

Semilunar Valves/Great Arteries

Contrast two-dimensional echocardiography in congenital heart disease: Techniques, indications and clinical utility

Noninvasive Doppler echocardiographic evaluation of shunt flow dynamics of the ductus arteriosus.

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