Assessment of pulmonary/systemic blood flow ratio after first-stage palliation for hypoplastic left heart syndrome Jack Rychik, MD, David M. Bush, MD,

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Presentation transcript:

Assessment of pulmonary/systemic blood flow ratio after first-stage palliation for hypoplastic left heart syndrome Jack Rychik, MD, David M. Bush, MD, PhD, Thomas L. Spray, MD, J.William Gaynor, MD, Gil Wernovsky, MD The Journal of Thoracic and Cardiovascular Surgery Volume 120, Issue 1, Pages 81-87 (July 2000) DOI: 10.1067/mtc.2000.106840 Copyright © 2000 American Association for Thoracic Surgery Terms and Conditions

Fig. 1 Echocardiographic image of arch reconstruction after first-stage palliation for HLHS. Asterisk marks the position in the descending aorta for Doppler interrogation and calculation of the DFR ratio. DAO, Descending aorta; PROX ARCH, proximal arch reconstruction. The Journal of Thoracic and Cardiovascular Surgery 2000 120, 81-87DOI: (10.1067/mtc.2000.106840) Copyright © 2000 American Association for Thoracic Surgery Terms and Conditions

Fig. 2 Doppler spectral display of the waveforms generated when sampling in the descending aorta after first-stage palliation for HLHS. Flow below the baseline represents antegrade flow in systole; flow above the baseline represents retrograde flow in diastole. The DFR ratio is calculated by measuring the velocity-time integral of retrograde and antegrade flow done by using planimetrics for the area under each curve and dividing the former by the latter. Three patients are exhibited. The top panel demonstrates a small amount of flow reversal, indicating low Qp/Qs; the middle panel demonstrates a moderate amount of flow reversal; and the lower panel demonstrates a large degree of reversal, indicating high Qp/Qs. The Journal of Thoracic and Cardiovascular Surgery 2000 120, 81-87DOI: (10.1067/mtc.2000.106840) Copyright © 2000 American Association for Thoracic Surgery Terms and Conditions

Fig. 3 Scatter plot of arterial saturation versus calculated Qp/Qs. The Y axis is shown by using a logarithmic scale. The Journal of Thoracic and Cardiovascular Surgery 2000 120, 81-87DOI: (10.1067/mtc.2000.106840) Copyright © 2000 American Association for Thoracic Surgery Terms and Conditions

Fig. 4 Scatter plot of arterial PO2 versus calculated Qp/Qs ratio. The Y axis is shown by using a logarithmic scale. The Journal of Thoracic and Cardiovascular Surgery 2000 120, 81-87DOI: (10.1067/mtc.2000.106840) Copyright © 2000 American Association for Thoracic Surgery Terms and Conditions

Fig. 5 Scatter plot of the pulse pressure versus calculated Qp/Qs. The Y axis is shown by using a logarithmic scale. The Journal of Thoracic and Cardiovascular Surgery 2000 120, 81-87DOI: (10.1067/mtc.2000.106840) Copyright © 2000 American Association for Thoracic Surgery Terms and Conditions

Fig. 6 Scatter plot of the superior vena cava saturation versus calculated Qp/Qs ratio. The Y axis is shown by using a logarithmic scale. The Journal of Thoracic and Cardiovascular Surgery 2000 120, 81-87DOI: (10.1067/mtc.2000.106840) Copyright © 2000 American Association for Thoracic Surgery Terms and Conditions

Fig. 7 Scatter plots with raw nontransformed data of DFR ratio versus calculated Qp/Qs (A) and predicted regression line for natural logarithm of the transformed DFR ratio versus a similarly transformed calculated Qp/Qs (B). Ninety-five percent confidence limits about the predicted line are shown. The natural logarithm scale is used on both the X and Y axes. Natural logarithm equation is provided. A DFR ratio of 0.35 predicts a calculated Qp/Qs of 1:1, and a DFR ratio of less than 0.5 suggests a Qp/Qs of less than 1.5:1. The Journal of Thoracic and Cardiovascular Surgery 2000 120, 81-87DOI: (10.1067/mtc.2000.106840) Copyright © 2000 American Association for Thoracic Surgery Terms and Conditions