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. 1984 Dec;52(6):633–640. doi: 10.1136/hrt.52.6.633

Quantification of left to right shunt in atrial septal defect using systolic time intervals derived from pulsed Doppler velocimetry.

C Veyrat, C Gourtchiglouian, S Bas, G Abitbol, D Kalmanson
PMCID: PMC481697  PMID: 6239641

Abstract

Systolic time intervals derived from Doppler velocimetry measurements were used instead of direct pulmonary to systemic flow ratio measurements in adults with atrial septal defect to quantify left to right atrial shunts. Thirteen normal subjects and 25 patients with uncomplicated atrial septal defect confirmed by cardiac catheterisation were studied. The pulmonary to systemic flow ratio (Qp:Qs) expressing the shunt size was determined by the Fick method; in normal subjects the Qp:Qs ratio was assumed to be equal to 1.0. The pulsed Doppler analogue velocity recording of flow in the pulmonary artery and the ascending aorta was taken as indicating the ejection time of each ventricle and the Q wave of the electrocardiogram as indicating the onset of systole. From these measurements the ratios of the pre-ejection periods to the ejection times (haemodynamic ratio) were calculated for each ventricle and the ratios of each variable (pre-ejection period, ejection time, and haemodynamic ratio) were calculated for both ventricles. Significant differences were found between the normal subjects and the patients with atrial septal defect for all these ratios. When the Doppler findings and the Fick measurements of Qp:Qs were compared the best linear correlation coefficient was for the left to right haemodynamic ratio. It is concluded that the use of a ratio involving several variables, such as the pre-ejection period and the ejection time for both ventricles, improves the reliability of this method, which appears to be applicable in adults.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Baker D. W., Rubenstein S. A., Lorch G. S. Pulsed Doppler echocardiography: principles and applications. Am J Med. 1977 Jul;63(1):69–80. doi: 10.1016/0002-9343(77)90119-x. [DOI] [PubMed] [Google Scholar]
  2. Griffith J. M., Henry W. L. An ultrasound system for combined cardiac imaging and Doppler blood flow measurement in man. Circulation. 1978 May;57(5):925–930. doi: 10.1161/01.cir.57.5.925. [DOI] [PubMed] [Google Scholar]
  3. Gullace G., Ribecca G. Tempi sistolici del ventricolo destro. Rilievi ecocardiografici. Minerva Cardioangiol. 1979 Nov;27(11):727–734. [PubMed] [Google Scholar]
  4. Hegrenaes L. Left ventricular systolic time intervals. A comparison between the conventional carotid pulse curve method and the doppler ultrasound method. Eur Heart J. 1983 May;4(5):313–319. doi: 10.1093/oxfordjournals.eurheartj.a061467. [DOI] [PubMed] [Google Scholar]
  5. Hirschfeld S., Meyer R., Schwartz D. C., Kofhagen J., Kaplan S. The echocardiographic assessment of pulmonary artery pressure and pulmonary vascular resistance. Circulation. 1975 Oct;52(4):642–650. doi: 10.1161/01.cir.52.4.642. [DOI] [PubMed] [Google Scholar]
  6. Hirschfeld S., Meyer R., Schwartz D. C., Korfhagen J., Kaplan S. Measurement of right and left ventricular systolic time intervals by echocardiography. Circulation. 1975 Feb;51(2):304–309. doi: 10.1161/01.cir.51.2.304. [DOI] [PubMed] [Google Scholar]
  7. Kitabatake A., Inoue M., Asao M., Ito H., Masuyama T., Tanouchi J., Morita T., Hori M., Yoshima H., Ohnishi K. Noninvasive evaluation of the ratio of pulmonary to systemic flow in atrial septal defect by duplex Doppler echocardiography. Circulation. 1984 Jan;69(1):73–79. doi: 10.1161/01.cir.69.1.73. [DOI] [PubMed] [Google Scholar]
  8. Leighton R. F., Weissler A. M., Weinstein P. B., Wooley C. F. Right and left ventricular systolic time intervals. Effects of heart rate, respiration and atrial pacing. Am J Cardiol. 1971 Jan;27(1):66–72. doi: 10.1016/0002-9149(71)90084-1. [DOI] [PubMed] [Google Scholar]
  9. Magnin P. A., Stewart J. A., Myers S., von Ramm O., Kisslo J. A. Combined doppler and phased-array echocardiographic estimation of cardiac output. Circulation. 1981 Feb;63(2):388–392. doi: 10.1161/01.cir.63.2.388. [DOI] [PubMed] [Google Scholar]
  10. Tsuda S., Fukushima M., Yasui K., Hamanaka Y., Inoue M., Abe H., Matsuo H. [Right and left ventricular systolic time intervals in patients with atrial septal defect measured by the ultrasonic Doppler method]. J Cardiogr. 1982 Jun;12(2):513–521. [PubMed] [Google Scholar]
  11. Tsuda S. Studies on right ventricular performance by non-invasive measurement of systolic and diastolic time intervals in patients with chronic right ventricular overloading. Jpn Circ J. 1978 Dec;42(12):1319-20, 1373-84. [PubMed] [Google Scholar]
  12. Veyrat C., Abitbol G., Berkman M., Malergue M. C., Kalmanson D. Diagnostic et évaluation par écho-Doppler pulsé des insuffisances tricuspidiennes et des communications interventriculaires et interauriculaires. Etude vélocimétrique des shunts. Arch Mal Coeur Vaiss. 1980 Sep;73(9):1037–1051. [PubMed] [Google Scholar]
  13. Veyrat C., Cholot N., Abitbol G., Kalmanson D. Non-invasive diagnosis and assessment of aortic valve disease and evaluation of aortic prosthesis function using echo pulsed Doppler velocimetry. Br Heart J. 1980 Apr;43(4):393–413. doi: 10.1136/hrt.43.4.393. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Veyrat C., Kalmanson D., Savier C. H., Chiche P. Diagnostic des communications inter-auricularies par l'étude des temps systoliques gauches en respiration profonde. Comparaison avec le sujet normal. Coeur Med Interne. 1972 Jul-Sep;11(3):451–479. [PubMed] [Google Scholar]
  15. Veyrat C., Kalmanson D., Savier C. H., Delabre M., Chiche P. Les temps systoliques gauches expiratoires des communications inteauriculaires au repos et sous nitrite d'amyle. Coeur Med Interne. 1972 Apr-Jun;11(2):229–247. [PubMed] [Google Scholar]
  16. Wanderman K. L., Ovsyshcher I., Gueron M. Left ventricular performance in patients with atrial septal defect: evaluation with noninvasive methods. Am J Cardiol. 1978 Mar;41(3):487–493. doi: 10.1016/0002-9149(78)90004-8. [DOI] [PubMed] [Google Scholar]
  17. Weissler A. M., Harris W. S., Schoenfeld C. D. Bedside technics for the evaluation of ventricular function in man. Am J Cardiol. 1969 Apr;23(4):577–583. doi: 10.1016/0002-9149(69)90012-5. [DOI] [PubMed] [Google Scholar]

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