Pulmonary Venous Doppler Flow Profile before and after Surgical Closure of Atrial Septal Defect in Children

Abstract

ABSTRACT Objectives A secundum atrial septal defect is associated with a characteristic pattern of continuous antegrade wave on a pulmonary venous Doppler flow profile. It is replaced with a regular S and D wave after the closure of defect. Although, a few published reports have described these features in adults, there are not enough studies in pediatric patients under anesthesia. Setting A tertiary referral center. Participants A total of 12 children with uncomplicated secundum atrial septal defect participated in the evaluation process. Interventions After anesthesia induction, three of them were excluded from detailed pulmonary venous study as they did not satisfy selection criteria. In remaining nine children, the intraoperative pulmonary venous Doppler changes were assessed before and after the defect closure, manually tracing the pulmonary venous waveforms. Measurements and main results The antegrade wave was observed in 9/9 patients before surgery that characteristically lacked distinct systolic and diastolic waves, although in seven patients, a larger systolic peak and a smaller diastolic peak were identified. Normal S and D waves were seen after termination of cardiopulmonary bypass with S/D ratio >1 in all cases. The maximum velocity of atrial retrograde wave increased and heart rate decreased significantly after surgery. Conclusion The continuous antegrade wave is a consistent pulmonary venous Doppler feature of an uncomplicated secundum ASD in anesthetized children. The Doppler pattern is normalized immediately after termination of cardiopulmonary bypass. How to cite this article Gadhinglajkar S, Sreedhar R, Menon S, Omprakash S. Pulmonary Venous Doppler Flow Profile before and after Surgical Closure of Atrial Septal Defect in Children. J Perioper Echocardiogr 2013;1(2):42-47.