Pulmonary Venous Doppler Flow Profile before and after Surgical Closure of Atrial Septal Defect in Children

Abstract

Objectives: A secundum atrial septal defect is associated with a characteristic pattern of continuous antegrade wave on a pulmonary venous Doppler flow profile. It is replaced with a regular S and D wave after the closure of defect. Although, a few published reports have described these features in adults, there are not enough studies in pediatric patients under anesthesia. Setting: A tertiary referral center.Participants: A total of 12 children with uncomplicated secundum atrial septal defect participated in the evaluation process.Interventions: After anesthesia induction, three of them were excluded from detailed pulmonary venous study as they did not satisfy selection criteria. In remaining nine children, the intraoperative pulmonary venous Doppler changes were assessed before and after the defect closure, manually tracing the pulmonary venous waveforms. Measurements and main results:The antegrade wave was observed in 9/9 patients before surgery that characteristically lacked distinct systolic and diastolic waves, although in seven patients, a larger systolic peak and a smaller diastolic peak were identified.Normal S and D waves were seen after termination of cardiopulmonary bypass with S/D ratio >1 in all cases. The maximum velocity of atrial retrograde wave increased and heart rate decreased significantly after surgery. Conclusion:The continuous antegrade wave is a consistent pulmonary venous Doppler feature of an uncomplicated secundum ASD in anesthetized children. The Doppler pattern is normalized immediately after termination of cardiopulmonary bypass.

The Complementary Value of Proximal Isovelocity Surface Area in Large Left-to-Right Lesions With Pulmonary Vein Stenosis

“…Gadhinglajkar et al . 8 reported increased turbulence across the pulmonary veins due to a large left-to-right shunt. Color Doppler interrogation of the RUPV in the present patient showed turbulence, but it was not clear whether this turbulence was due to increased flow across the pulmonary veins due to a large left-to-right shunt or to pulmonary venous obstruction.…”