Abstract
Objective—To find how closely pressure gradients across the aortic arch derived from Doppler echocardiography reflect gradients measured by catheter after surgical repair of coarctation of the aorta.
Design—Pressure drop across the aortic arch was measured simultaneously by continuous wave Doppler and double lumen catheter in 20 patients with repaired coarctation of the aorta.
Results—The peak pressure drop estimated by Doppler was almost invariably higher than the peak to peak gradient measured by catheter, as might be expected. Wide variation was seen between the Doppler measured pressure drop and instantaneous peak gradient measured by catheter, ranging from +22 to −17 mm Hg. The reasons for these differences are unclear but are probably related to a combination of complex flow dynamics in the aortic arch, difficulty in closely aligning the Doppler beam with flow, and inability to measure flow velocity immediately proximal to the site of the surgical repair with continuous wave Doppler.
Conclusions—Continuous wave Doppler echocardiography may significantly overestimate or underestimate the pressure drop after repair of coarctation and it should be interpreted with caution in individual patients. Catheterisation with angiography remains the reference standard for assessment of surgical repair of the aortic arch.
Selected References
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- Aldousany A. W., DiSessa T. G., Alpert B. S., Birnbaum S. E., Willey E. S. Significance of the Doppler-derived gradient across a residual aortic coarctation. Pediatr Cardiol. 1990 Jan;11(1):8–14. doi: 10.1007/BF02239541. [DOI] [PubMed] [Google Scholar]
- Bland J. M., Altman D. G. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986 Feb 8;1(8476):307–310. [PubMed] [Google Scholar]
- Carvalho J. S., Redington A. N., Shinebourne E. A., Rigby M. L., Gibson D. Continuous wave Doppler echocardiography and coarctation of the aorta: gradients and flow patterns in the assessment of severity. Br Heart J. 1990 Aug;64(2):133–137. doi: 10.1136/hrt.64.2.133. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Currie P. J., Hagler D. J., Seward J. B., Reeder G. S., Fyfe D. A., Bove A. A., Tajik A. J. Instantaneous pressure gradient: a simultaneous Doppler and dual catheter correlative study. J Am Coll Cardiol. 1986 Apr;7(4):800–806. doi: 10.1016/s0735-1097(86)80339-4. [DOI] [PubMed] [Google Scholar]
- Gibbs J. L. Ultrasound and coarctation of the aorta. Br Heart J. 1990 Aug;64(2):109–110. doi: 10.1136/hrt.64.2.109. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Houston A. B., Simpson I. A., Pollock J. C., Jamieson M. P., Doig W. B., Coleman E. N. Doppler ultrasound in the assessment of severity of coarctation of the aorta and interruption of the aortic arch. Br Heart J. 1987 Jan;57(1):38–43. doi: 10.1136/hrt.57.1.38. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Marx G. R., Allen H. D. Accuracy and pitfalls of Doppler evaluation of the pressure gradient in aortic coarctation. J Am Coll Cardiol. 1986 Jun;7(6):1379–1385. doi: 10.1016/s0735-1097(86)80160-7. [DOI] [PubMed] [Google Scholar]
- Rao P. S., Carey P. Doppler ultrasound in the prediction of pressure gradients across aortic coarctation. Am Heart J. 1989 Aug;118(2):299–307. doi: 10.1016/0002-8703(89)90189-0. [DOI] [PubMed] [Google Scholar]
- Scott P. J., Wharton G. A., Gibbs J. L. Failure of Doppler ultrasound to detect coarctation of the aorta. Int J Cardiol. 1990 Sep;28(3):379–381. doi: 10.1016/0167-5273(90)90325-y. [DOI] [PubMed] [Google Scholar]
- Teirstein P. S., Yock P. G., Popp R. L. The accuracy of Doppler ultrasound measurement of pressure gradients across irregular, dual, and tunnellike obstructions to blood flow. Circulation. 1985 Sep;72(3):577–584. doi: 10.1161/01.cir.72.3.577. [DOI] [PubMed] [Google Scholar]
- Wilson N., Sutherland G. R., Gibbs J. L., Dickinson D. F., Keeton B. R. Limitations of Doppler ultrasound in the diagnosis of neonatal coarctation of the aorta. Int J Cardiol. 1989 Apr;23(1):87–89. doi: 10.1016/0167-5273(89)90333-1. [DOI] [PubMed] [Google Scholar]