RESUMEN
A 5 MHz range-gated portable pulsed Doppler velocity meter was used to measure mean ascending aortic blood flow velocity noninvasively. Studies were performed from a suprasternal approach in 18 preterm infants with patent ductus arteriosus. Measurements were made in each patient before and after medical or surgical closure of the PDA. The internal ascending aortic diameter was determined echocardiographically and aortic cross-sectional area calculated according to the equation AAo = pi d2/4. Ascending aortic blood flow was computed as QAo (ml/min) = VAo (cm/sec) x AAo (cm2) x 60 (sec/min). Prior to PDA closure, QAo averaged 343 ml/min/kg, well above predicted normal values. After PDA closure, QAo fell to 252 ml/min/kg, significantly lower than the preclosure level (P less than 0.001), but slightly higher than the mean cardiac output of healthy newborn infants. The mean QAo after surgical ligation of the PDA was closer to the predicted normal value than after treatment with indomethacin alone. This study reflects the effect of left-to-right ductus shunting on left ventricular output and emphasizes the demands placed on the neonatal left ventricle by PDA.
Asunto(s)
Gasto Cardíaco , Conducto Arterioso Permeable/fisiopatología , Enfermedades del Prematuro/fisiopatología , Conducto Arterial/cirugía , Conducto Arterioso Permeable/cirugía , Ventrículos Cardíacos/fisiopatología , Humanos , Recién Nacido , Enfermedades del Prematuro/cirugíaRESUMEN
Mean blood flow velocity (VAo) in the ascending aorta was measured noninvasively in 33 children, ages 3 days to 17 years, by pulsed Doppler technique at the time of cardiac catheterization. Measurements were made from a suprasternal approach with a portable, range-gated device. The ascending aortic diameter was determined echocardiographically and aortic cross sectional area calculated (A = pi d2/4 cm2). Aortic flow (QAo) was computed from Doppler recordings: QAo (ml/minute) = VAo (cm/second) X A (cm2) X 60 (second/minute). Values were compared with cardiac outputs determined according to the Fick principle, using measured oxygen consumption calculated oxygen capacity, and oxygen saturation. Subjects with aortic valve abnormalities or left ventricular outflow tract obstruction were excluded from study. Agreement between the two methods was excellent (linear regression r = 0.98, slope = 1.07, y-intercept = -4.5 ml, range 403 to 5.540 ml/minute). The Doppler technique is a quick, noninvasive, and accurate method of determining ascending aortic blood flow in neonates and children.