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

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Rivera, Ivan Romero [UNIFESP]
Mendonca, Maria Alayde [UNIFESP]
Andrade, Jose Lazaro [UNIFESP]
Moises, Valdir [UNIFESP]
Campos, Orlando [UNIFESP]
Silva, Celia Camelo [UNIFESP]
Carvalho, Antonio Carlos [UNIFESP]
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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 VTIpv 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 VTIpv increased significantly from 22.6 +/- 4.7 cm to 28.1 +/- 6.2 cm (P = 0.0002) after 100% oxygen inhalation. VTIpv 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 VTIpv 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.
Echocardiography-a Journal of Cardiovascular Ultrasound and Allied Techniques. Hoboken: Wiley-Blackwell, v. 30, n. 8, p. 952-960, 2013.