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Accuracy of Doppler-Derived Estimation of Pulmonary Vascular Resistance in Congenital Heart Disease: An Index of Operability

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Abstract

Pulmonary vascular resistance (PVR) is a critical and essential parameter during the assessment and selection of modality of treatment in patients with congenital heart disease (CHD) accompanied by pulmonary arterial hypertension (PAH). Cardiac catheterization is the “gold standard” but is an invasive method for PVR measurement. A noninvasive and reliable method for estimation of PVR in children has been a major challenge and most desirable during past decades, especially for those who need repeated measurements. In a prospective study and among consecutive patients who were referred for cardiac catheterizations, PVR was calculated as the ratio of the transpulmonary pressure gradient (∆P) to the amount of the pulmonary flow (QP) accordingly for 20 patients with CHD and high PAH. Subsequently and noninvasively, PVR was assessed for these patients by a Doppler echocardiography-derived index defined as the ratio of the tricuspid regurgitation velocity (TRVm/s) to the velocity time integral (VTIcm) of the right-ventricular outflow tract (RVOT). There was a good correlation between PVR measured at catheterization (PVRcath) and TRV/VTIm ratio; the mean of three measurements of VTI (VTIm) with R 2 = 0.53 (p = 0.008). In addition, a TRV/VTIm value of 0.2 provided a sensitivity of 71.4% and a specificity of 100% for PVR >6 Woods units (WU) as well as sensitivity of 90% and specificity of 90% for a PVR equal to 8 WU. PVR value between 6 and 8 WU by catheterization has been considered as a cut-off point for intervention in children with left-to-right shunts and PAH. In conclusion, Doppler-derived TRV/VTIm ratio is a reliable index that may be helpful as a supplementary diagnostic tool for the selection of modality of treatment and follow-up of patients with PAH and increased PVR.

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Acknowledgments

This work was financially supported by Vice Chancellor for Research of Shiraz University of Medical Sciences. We thank K. Shashok (AuthorAID in the Eastern Mediterranean) for improving the use of English in the manuscript and M. Gholami for research assistance. The investigators thank A. R. Mirahmadizadeh, epidemiologist, and H. Tabesh, biostatistics, for providing statistical analysis of the data. We also thank S. Akbarzadeh for secretarial assistance.

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  1. Department of Pediatrics, Division of Pediatric Cardiology, Namazi Hospital, Shiraz University of Medical Sciences, 71937-11351, Shiraz, Iran

    Gholam Hossein Ajami, Sirous Cheriki, Hamid Amoozgar, Mohammad Borzouee & Manoucher Soltani

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  1. Gholam Hossein Ajami
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  2. Sirous Cheriki
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  3. Hamid Amoozgar
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  4. Mohammad Borzouee
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  5. Manoucher Soltani
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Correspondence to Gholam Hossein Ajami.

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Ajami, G.H., Cheriki, S., Amoozgar, H. et al. Accuracy of Doppler-Derived Estimation of Pulmonary Vascular Resistance in Congenital Heart Disease: An Index of Operability. Pediatr Cardiol 32, 1168–1174 (2011). https://doi.org/10.1007/s00246-011-0035-4

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  • DOI: https://doi.org/10.1007/s00246-011-0035-4

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