Pulsed Doppler echocardiographic detection of obstruction of systemic venous return after repair of transposition of the great arteries.

Abstract

Pulsed Doppler echocardiography (PDE) allows the detection of direction and quality (smooth vs disturbed, or "rough") of blood flow characteristics at known sites within the heart and great vessels. In order to test the ability of this technique to detect obstruction of systemic venous return after interatrial repair of transposition of the great arteries, twelve children who had undergone such surgery were examined by PDE. The blood flow characteristics in the systemic venous return atrium in the children were compared with invasive pressure measurements in the venae cavae and systemic venous return atrium. Six children without measurable baffle gradients had phasic diastolic flow characteristics in the systemic venous return atrium similar to the normal. All six children who had a gradient between the cava and systemic venous return atrium of 3 mm Hg or more had nonphasic disturbed blood flow in the systemic venous return atrium during diastole. We conclude that 1) PDE offers simple and specific detection of atrial flow patterns in infants who have had interatrial repair of transposition of the great arteries; 2) the detection of nonphasic disturbed atrial flow during diastole strongly suggests the presence of obstruction to systemic venous return; and 3) the detection of phasic atrial flow suggests the absence of significant obstruction.