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Accuracy of Doppler Methods for Estimating Peak-to-Peak and Peak Instantaneous Gradients Across Coarctation of the Aorta: An In Vitro Study

Seifert, Barbara L. and DesRochers, Keith and Ta, Mindy and Giraud, George and Zarandi, Mehradad and Gharib, Morteza and Sahn, David J. (1999) Accuracy of Doppler Methods for Estimating Peak-to-Peak and Peak Instantaneous Gradients Across Coarctation of the Aorta: An In Vitro Study. Journal of the American Society of Echocardiography, 12 (9). pp. 744-753. ISSN 0894-7317. https://resolver.caltech.edu/CaltechAUTHORS:20130912-092348394

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Abstract

Although data exist that address the attempt to correlate noninvasive Doppler-derived pressure gradients with invasive catheter pressure gradients in patients with coarctation of the aorta, few data exist about stiffness of the proximal descending aorta (precoarctation) and its relation to these pressure measurements. In this study, an in vitro flow model of a simulated neonatal aorta with a coarctation was developed. Three proximal descending aortas of different stiffnesses were used. The stiffness index of the proximal descending aorta was calculated as β = ln [systolic pressure/diastolic pressure/(systolic diameter – diastolic diameter)]. We evaluated pressure gradients obtained by continuous wave Doppler and standard catheter methods and looked at acceleration of flow velocity determined by pulsed wave Doppler in the 3 precoarctation segments of differing stiffnesses. Pressures in the proximal descending aorta (precoarctation) increased with increasing stiffness, ranging from 105 mm Hg (soft) to greater than 300 mm Hg (stiff). Continuous wave Doppler instantaneous pressure gradients overestimated the catheter instantaneous pressure gradients substantially (mean 41% ± 19%). The stiffer the precoarctation segment, the more the degree of overestimation: soft, 0% to 63% (= 3.47); medium, 13% to 54% (β = 4.42); and stiff, 43% to 66% (β = 5.91). Inclusion of the precoarctation velocity [V1] component in the Bernoulli equation did not significantly improve the correlation or the agreement. An additional observation was that pullback catheter peak-to-peak gradients were higher than simultaneous peak-to-peak gradients. In the stiff aorta, this difference could be greater than 22 mm Hg (>19%). Acceleration of flow velocity toward the coarctation was evident by pulsed wave Doppler interrogation. Increasing the stiffness of the precoarctation segment also increased the degree of acceleration within this proximal segment: soft, 0.4 to 0.8 m/s; medium, 0.5 to 1.4 m/s; and stiff, 0.7 to 1.5 m/s. These data suggest that increasing stiffness of the proximal descending aorta can alter the continuous wave detected Doppler gradient and although the gradient itself has increased, it may not predict accurately the true severity of the localized, most severely obstructed segment.


Item Type:Article
Related URLs:
URLURL TypeDescription
http://dx.doi.org/10.1016/S0894-7317(99)70025-8DOIArticle
http://www.sciencedirect.com/science/article/pii/S0894731799700258PublisherArticle
Additional Information:© 1999 by the American Society of Echocardiography.
Group:GALCIT
Issue or Number:9
Record Number:CaltechAUTHORS:20130912-092348394
Persistent URL:https://resolver.caltech.edu/CaltechAUTHORS:20130912-092348394
Official Citation:Barbara L. Seifert, Keith DesRochers, Mindy Ta, George Giraud, Mehradad Zarandi, Morteza Gharib, David J. Sahn, Accuracy of Doppler Methods for Estimating Peak-to-Peak and Peak Instantaneous Gradients Across Coarctation of the Aorta: An In Vitro Study, Journal of the American Society of Echocardiography, Volume 12, Issue 9, September 1999, Pages 744-753, ISSN 0894-7317, http://dx.doi.org/10.1016/S0894-7317(99)70025-8. (http://www.sciencedirect.com/science/article/pii/S0894731799700258)
Usage Policy:No commercial reproduction, distribution, display or performance rights in this work are provided.
ID Code:41276
Collection:CaltechAUTHORS
Deposited By: Tony Diaz
Deposited On:13 Sep 2013 16:11
Last Modified:03 Oct 2019 05:47

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