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Pulmonary Venous Flow Index as a Predictor of Pulmonary Vascular Resistance Variability in Congenital Heart Disease with Increased Pulmonary Flow: A Comparative Study before and after Oxygen Inhalation
Author(s) -
Rivera Ivan Romero,
Mendonça Maria Alayde,
Andrade José Lázaro,
Moises Valdir,
Campos Orlando,
Silva Célia Camelo,
Carvalho Antonio Carlos
Publication year - 2013
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/echo.12163
Subject(s) - medicine , vascular resistance , cardiology , inhalation , pulmonary hypertension , doppler echocardiography , cardiac index , cardiac catheterization , heart disease , venous blood , hemodynamics , cardiac output , anesthesia , diastole , blood pressure
Aims There is no definitive and reliable echocardiographic method for estimating the pulmonary vascular resistance ( PVR ) to differentiate persistent vascular disease from dynamic pulmonary hypertension. The aim of this study was to analyze the relationship between the pulmonary venous blood flow velocity‐time integral ( VTIpv ) and PVR . Methods and Results Eighteen patients (10 females; 4 months to 22 years of age) with congenital heart disease and left to right shunt were studied. They underwent complete cardiac catheterization, including measurements of the PVR and Qp:Qs ratio, before and after 100% oxygen inhalation. Simultaneous left inferior pulmonary venous flow VTI pv was obtained by Doppler echocardiography. The PVR decreased significantly from 5.0 ± 2.6 W to 2.8 ± 2.2 W (P = 0.0001) with a significant increase in the Qp:Qs ratio, from 3.2 ± 1.4 to 4.9 ± 2.4 (P = 0.0008), and the VTI pv increased significantly from 22.6 ± 4.7 cm to 28.1 ± 6.2 cm (P = 0.0002) after 100% oxygen inhalation. VTI pv correlated well with the PVR and Qp:Qs ratio (r = −0.74 and 0.72, respectively). Diagnostic indexes indicated a sensitivity of 86%, specificity of 75%, accuracy of 83%, a positive predictive value of 92% and a negative predictive value of 60%. Conclusion The VTI pv correlated well with the PVR . The measurement of this index before and after oxygen inhalation may become a useful noninvasive test for differentiating persistent vascular disease from dynamic and flow‐related pulmonary hypertension.