title: [The accuracy of Doppler echocardiography determination of shunt volume in children with isolated atrial septal defect and left-right shunt].
abstract: The accuracy of shunt calculations derived from Doppler echocardiography was assessed in 15 children (5-15 years, mean 8.5 yrs.) with secundum-type atrial septal defect and left-to-right (L-R) shunt. Qp/Qs was calculated by measuring stroke volumes over the aorta and pulmonary artery prior to and 4-15 days after corrective surgery. The measuring error of the Doppler method was defined as deviation of the postoperative shunt value from zero. A residual shunt was excluded by careful intraoperative testing and physical examination. Intraoperative inspection revealed normal pulmonary venous drainage. L-R-shunt, as calculated by Doppler echo, significantly decreased after surgery (p less than 0.001). Although all septal defects were closed, calculations by Doppler echo resulted in a median residual shunt of 16% (0-50.7%). IN 2/15 children a L-R shunt of more than 40% was derived by echo recordings. The size of the measuring error increased in children with great preoperative shunts. There was a significant correlation between the ratio of pulmonary to aortic cross-sectional area and the measuring error (p less than 0.03, r = 0.59). Poor estimation of cross-sectional areas in dilated pulmonary arteries was the most important limiting factor in shunt calculation. Doppler echocardiography provides a valuable noninvasive method for shunt calculation. Similarly to Fick's principle, in some patients the measuring error may be considerable and become relevant for clinical decisions. Thus Doppler-derived shunt calculations must be complemented by additional information of two-dimensional echo and physical examination.
authors.affiliation: Kinderkardiologie des Deutschen Herzzentrums München und Kinderklinik, TU München.
authors.forename: H
authors.initials: H
authors.lastname: Stern
authors.forename: M
authors.initials: M
authors.lastname: Vogel
authors.forename: P
authors.initials: P
authors.lastname: Emmrich
authors.forename: K
authors.initials: K
authors.lastname: Bühlmeyer
mesh_terms: D000293:Adolescent; D001783:Blood Flow Velocity / Q000502:physiology; D001810:Blood Volume / Q000502:physiology*; D002648:Child; D002675:Child, Preschool; D015150:Echocardiography, Doppler / Q000379:methods*; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D006346:Heart Septum / Q000503:physiopathology; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis; D011652:Pulmonary Circulation / Q000502:physiology
vernacular_title: Genauigkeit dopplerechokardiographischer Shuntgrössenbestimmung bei Kindern mit isoliertem Vorhofseptumdefekt und Links-rechts-Shunt.