title: Quantitative assessment of pulmonary insufficiency by Doppler echocardiography in patients with adult congenital heart disease.
abstract: We determined the utility of continuous wave (CW) Doppler for quantification of pulmonary insufficiency (PI) confirmed by pulmonary angiography in patients with postoperative adult congenital heart disease. A total of 41 patients with PI were divided into two groups on the basis of PI severity by pulmonary angiography: group A (n = 27) with severe PI and group B (n = 14) with mild or moderate PI. Nine patients in group A had pulmonic valve replacement and reverted to mild PI after surgery. Their pre- and postoperative data were compared. All underwent a two-dimensional/Doppler study with interrogation of the PI jet for jet width by color Doppler and peak flow velocity, deceleration time (DT), pressure half-time (PHT), diastolic period (DP), and PI flow time (FT) by CW Doppler. The no-flow time (NFT), NFT/FT ratio, and NFT/DP fraction were calculated. Group A had a larger right ventricle (4.1 +/- 0.9 vs. 3.5 +/- 0.6 cm, P = .033), higher PI peak velocity (2.1 +/- 0.5 vs. 1.7 +/- 0.5 m/s, P = .04), shorter DT (261 +/- 61 vs. 317 +/- 83 ms, P = .018) and PHT (76 +/- 29 vs. 132 +/- 53, P < .0001), longer NFT (146 +/- 66 vs. 40 +/- 42 ms, P < .0001), and higher ratios of NFT/FT (46% +/- 27% vs. 13% +/- 14%, P < .0001) and NFT/DP (29% +/- 13% vs. 10% +/- 9%, P < .0001). The PHT and DT lengthened, and the NFT shortened in patients who underwent pulmonic valve replacement (all P < .05). By binary logistic regression, NFT and PHT were the best predictors for severe PI. An NFT of 80 ms had 84% sensitivity and 93% specificity, and a PHT of 100 ms had 93% sensitivity and 93% specificity for identifying angiographically severe PI. CW Doppler accurately distinguishes severe from lesser degrees of PI in patients with postoperative adult congenital heart disease.
authors.affiliation: Department of Cardiology, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Hua
authors.initials: H
authors.lastname: Yang
authors.forename: Min
authors.initials: M
authors.lastname: Pu
authors.forename: Charles E
authors.initials: CE
authors.lastname: Chambers
authors.forename: Howard S
authors.initials: HS
authors.lastname: Weber
authors.forename: John L
authors.initials: JL
authors.lastname: Myers
authors.forename: William R
authors.initials: WR
authors.lastname: Davidson
mesh_terms: D000328:Adult; D000792:Angiography; D006328:Cardiac Catheterization; D006348:Cardiac Surgical Procedures / Q000379:methods; D015331:Cohort Studies; D018618:Echocardiography, Doppler, Color / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery; D019918:Heart Valve Prosthesis Implantation / Q000379:methods; D006801:Humans; D016015:Logistic Models; D008297:Male; D011182:Postoperative Care / Q000379:methods; D011237:Predictive Value of Tests; D011665:Pulmonary Valve Insufficiency / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D014655:Vascular Resistance