title: Can Doppler systemic venous flow indices predict central venous pressure in children?
abstract: Tricuspid valve, superior vena cava (SVC), and hepatic vein Doppler patterns may be abnormal in right heart anomalies and have been used to predict high central venous pressure (CVP) in adults. The purpose of this study was to evaluate the relationship of these systemic venous flow indices to CVP in children. Children undergoing cardiac catheterization were studied prospectively using simultaneous recordings of mean CVP with pulsed-Doppler tracings of SVC, hepatic vein, and tricuspid valve flow. Systemic venous Doppler measurements included peak velocities and velocity time integrals for ventricular systole (S), ventricular diastole (D), and ventricular systole (B), and atrial systole (A). Tricuspid inflow Doppler E and A waves were recorded also. Patients with significant tricuspid stenosis or regurgitation, systemic venous obstruction, and nonsinus rhythm were excluded. The 42 patients ranged in age from 0.2 to 21.0 years and in weight from 3.0 to 68.0 kg. Mean CVPs ranged from 1 to 17 mmHg. Catheterization indications included hemodynamic evaluation (25 patients), transplant biopsy, (11 patients), and interventional procedures (6 patients). No SVC or tricuspid valve Doppler measurement correlated with CVP. Hepatic vein peak D, peak B, and peak A significantly correlated with CVP (r = 0.34 - 0.55; P < 0.05, linear regression). For all correlations, the r values were low with significant overlap among patients. Thus, in children, only hepatic vein peak velocities correlate with CVP. Because of the low r values and significant overlap among patients, the currently used Doppler indices have a low sensitivity for predicting CVP in this age group.
authors.affiliation: Primary Children's Medical Center, 100 North Medical Drive, Suite 1500, Salt Lake City, Utah 84113, USA.
authors.forename: S
authors.initials: S
authors.lastname: Ritter
authors.forename: L Y
authors.initials: LY
authors.lastname: Tani
authors.forename: R E
authors.initials: RE
authors.lastname: Shaddy
authors.forename: R W
authors.initials: RW
authors.lastname: Day
authors.forename: G S
authors.initials: GS
authors.lastname: Orsmond
authors.forename: L T
authors.initials: LT
authors.lastname: Pagotto
authors.forename: L L
authors.initials: LL
authors.lastname: Minich
mesh_terms: D000293:Adolescent; D000328:Adult; D001783:Blood Flow Velocity; D006328:Cardiac Catheterization; D002496:Central Venous Pressure / Q000502:physiology*; D002648:Child; D002675:Child, Preschool; D018619:Echocardiography, Doppler, Pulsed; D006503:Hepatic Veins / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D007223:Infant; D009200:Myocardial Contraction; D011379:Prognosis; D011446:Prospective Studies; D015203:Reproducibility of Results; D014261:Tricuspid Valve / Q000000981:diagnostic imaging* / Q000503:physiopathology; D014262:Tricuspid Valve Insufficiency / Q000000981:diagnostic imaging / Q000503:physiopathology; D014264:Tricuspid Valve Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology; D014683:Vena Cava, Superior / Q000000981:diagnostic imaging* / Q000503:physiopathology