A Study on the Accuracy of Pulmonary to Systemic Flow Ratio by Echocardiography in Patients with Atrial Septal Defect

DOI
  • Iwazaki Mihoka
    Department of Medical Technology, Gunma Prefectural Cardiovascular Center
  • Toide Hiroyuki
    Department of Medical Technology, Gunma Prefectural Cardiovascular Center
  • Okaniwa Hiroki
    Department of Medical Technology, Gunma Prefectural Cardiovascular Center
  • Yoshizumi Kiyoko
    Department of Medical Technology, Gunma Prefectural Cardiovascular Center
  • Araseki Tomomi
    Department of Medical Technology, Gunma Prefectural Cardiovascular Center
  • Kobayashi Yasuyuki
    Department of Medical Technology, Gunma Prefectural Cardiovascular Center
  • Yamashita Eiji
    
Department of Cardiology, Gunma Prefectural Cardiovascular Center

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Other Title
  • 心房中隔欠損症における心エコー肺体血流量比の精度に関する検討

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Purpose: To clarify the measurement accuracy of pulsed-Doppler method (Echo method) in pulmonary to systemic flow ratio (Qp/Qs) in patients with atrial septal defect (ASD).<br>Subjects and Methods: We enrolled 31 consecutive ASD patients who underwent the Echo and Fick method (53±18 years, 11 males). According to Qp/Qs values obtained by two methods, the patients were divided into 3groups: match-group (Within 20% of the difference of Qp/Qs between Echo and Fick method, n＝18), underestimate-group (more than 20% lower Qp/Qs by Echo method, n＝6) and overestimate-group (more than 20% higher Qp/Qs by Echo method, n＝7)．LVOT and RVOT diameter (RVOTd), and body surface revision level of each measurement item, left and right ventricular ejection bleeding flow time speed integral value, and the angle formed by RVOTd and ultrasonic beam in RVOTd measurement cross section (RVOTd measurement angle) were compared among 3 groups.<br>Results and Discussion: In overall, good correlation was observed between Qp/Qs by Echo and Fick method (r＝0.70, p<0.01). Four patients (67%) of underestimate-group showed Qp/Qs values of 3 to 4 (3≤Qp/Qs<4) by Fick method. Five patients (71%) of overestimate-group had Qp/Qs values of 2 to 3 (2≤Qp/Qs<3) by Fick method. Compared with the match-group (3≤Qp/Qs<4: 17.4±2.0 mm/m2, 2≤Qp/Qs<3: 19.3±1.3 mm/m2), RVOTd indexed by body surface area was significantly lower in underestimate-group (14.6±0.9 mm/m2, p<0.05), and larger in overestimate-group (22.7±3.7 mm/m2, p<0.05). Compared to the match-group (31.9±17.1 degree), both underestimate- and overestimate-group showed larger RVOTd measurement angle (65.0±4.5 degree, p<0.01, 63.6±11.8 degree, p<0.01), which suggests that ultrasound beam parallel to RVOT wall could induce larger measurement error of RVOT diameter due to lower lateral resolution than axial resolution or various artifacts.<br>Conclusion: In the measurement of RVOT, ultrasound beam perpendicular to RVOT wall could provide higher accuracy of Qp/Qs.

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