Quantitative Assessment of Pulmonary Insufficiency by Doppler Echocardiography in Patients with Adult Congenital Heart Disease

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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.

Original languageEnglish (US)
Pages (from-to)157-164
Number of pages8
JournalJournal of the American Society of Echocardiography
Volume21
Issue number2
DOIs
StatePublished - Feb 1 2008

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Doppler Echocardiography
Heart Diseases
Lung
Deceleration
Pressure
Angiography
Sensitivity and Specificity

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

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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.",
author = "Hua Yang and Min Pu and Charles Chambers and Howard Weber and John Myers and William Davidson",
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T1 - Quantitative Assessment of Pulmonary Insufficiency by Doppler Echocardiography in Patients with Adult Congenital Heart Disease

AU - Yang, Hua

AU - Pu, Min

AU - Chambers, Charles

AU - Weber, Howard

AU - Myers, John

AU - Davidson, William

PY - 2008/2/1

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N2 - 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.

AB - 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.

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