Quantitative, non-invasive assessment of ventricular septal defect shunt flow by measuring proximal isovelocity surface area on colour Doppler mapping.
OBJECTIVE
To determine whether the proximal isovelocity surface area (PISA) method could be applied to estimate the magnitude of ventricular septal defect (VSD) shunt flow.


METHODS
Prospective analysis of clinical, echocardiographic, and angiographic data.


METHODS
University hospital.


METHODS
14 children with VSD.


METHODS
Colour Doppler images of VSD shunt flow were obtained in parasternal long axis view, four chamber view or both, adjusted to provide the best imaging of flow. The VSD shunt flow rate and shunt volume were calculated as follows: shunt flow rate (SFR) = 2 pi r2 V/BSA in ml/s/m2; shunt volume = SFR x shunt duration time. The shunt volume, shunt fraction, and pulmonary to systemic flow ratio (Qp:Qs) were confirmed by cardiac catheterisation.


RESULTS
There was a correlation between shunt variables determined by PISA and those by catheterisation, including shunt volume (r = 0.78, P = 0.001) and shunt fraction (r = 0.74, P = 0.003). Qp:Qs was also significantly correlated with SFR (r = 0.79, P = 0.0007). The SFR was significantly different between the four patients with Qp:Qs < 2.0 (mean (SD) 54 (33) ml/s/m2) and the 10 patients with Qp:Qs > 2.0 (186 (69) ml/s/m2) (P = 0.004).


CONCLUSIONS
These data suggest that the PISA method is a reliable non-invasive investigation for the quantitative assessment of VSD shunt flow and provides important information for decisions regarding surgical repair.
Kurotobi
S
S
Department of Pediatrics, University Medical School, Osaka, Japan.
Sano
T
T
Matsushita
T
T
Takeuchi
M
M
Kogaki
S
S
Miwatani
T
T
Okada
S
S
D006328:Cardiac Catheterization; D002309:Cardiology / Q000379:methods; D002648:Child; D002675:Child, Preschool; D018618:Echocardiography, Doppler, Color; D005260:Female; D006345:Heart Septal Defects, Ventricular / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D007223:Infant; D008297:Male; D011446:Prospective Studies; D012039:Regional Blood Flow; D012044:Regression Analysis