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Phasic Blood Flow Velocity at a Potts Anastomosis Measured with the Doppler Flowmeter-Catheter
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I
GRAPHIC TECHNIQUES IN CARDIOLOGY
Phasic Blood Flow Velocity at a Potts Anastomosis Measured with the Doppler Flowmeter-Catheter* Alberto Benchimol, A-f.D., F.C.C.P.; Flavio Reich, M.D.; and Kenneth B. Desser, M.D., F.G.G.P.
Sinee
the introduction of Potts' aortopulmonary procedure! for palliative treatment of tetralogy of FalIot, numerous indirect methods have been utilized for evaluation of anastomotic patency.i" The purpose of this paper is to describe phasic, instantaneous, blood-velocity waveforms of a Potts anastomosis in a closed-chest human subject. Figure 1 shows the simultaneously recorded lead 2 of the electrocardiogram, right ventricular pressure, and phasic blood flow velocity within the Potts anastomosis of a 22-year-old man with tetralogy of Fallot, Blood How velocity was measured by introo From
the Institute for Cardiovascular Diseases, Good Samaritan Hospital, Phoenix, Ariz. Supported in part by the E. Nichols and Kim Sigsworth Memorial Funds. Reprint requests: Dr. Benchimol, PO Box 2989, Phoenix 85062
FLOW VELOCITY AT POTT S ANASTOMOSIS
0------------------·-0 FIGURE 1. Simultaneously recorded lead 2 (UI) of electrocardiogram, right ventricular (RV) pressure, and blood How velocity within Potts anastomosis of 22-year-old man with tetralogy of Fallot.
820 BENCHIMOL, REICH, DESSER
duction of a Doppler ultrasonic flowmeter-catheter into the aortic origin" of the anastomosis. Blood velocity was phasic and continuous throughout systole and diastole with a dominant diastolic fraction. Figure 2 shows lead 2 of the electrocardiogram, tricuspid area phonocardiogram, right atrial pressure, and phasic blood velocity when the catheter tip was withdrawn to the aortic origin of the anastomosis. Note systolic and diastolic murmurs which correspond to the major blood velocities recorded during these periods of the cardiac cycle. To our knowledge, this is the first description of phasic Potts anastomotic blood velocity directly measured in an intact, closed-chest human subject. This report emphasizes the feasibility of utilizing a Doppler Howmeter-catheter for evaluating and graphically displaying shunt blood velocity in patients with such an operation.
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FIGURE 2. Simultaneously recorded lead 2 (LII) of electrocardiogram, tricuspid area ( T A) phonocardiogram, right atrial (RA) pressure, and phasic blood flow velocity at aortic origin of Potts anastomosis in 22-year-old man with tetralogy of Fallot.
CHEST, 68: 6, DECEMBER, 1975
REFERENCES
Potts WJ, Smith S, Gibson S: Anastomosis of the aorta to a pulmonary artery: Certain types in congenital heart disease. JAMA 132:627-631, 1946 2 von Bernuth G, Ritter DO, Frye RL, et al: Evaluation of patients with tetralogy of Fallot and Potts anastomosis. Am J Cardiol27 :259-263, 1971 3 Ross RS, Taussig HB, Evans MH: Late hemodynamic complications of anastomotic surgery for the treatment of the tetralogy of Fallot. Circulation 18:553-561, 1958 4 McGaH CJ, Ross RS, Braunwald E: The development of
elevated pulmonary vascular resistance in man following increased pulmonary blood flow from systemic-pulmonary anastomosis. Am J Med 33:201-212.1962 5 Braunwald E, Cornell WP: A simplified technic for the detection of patent ductus arteriosus and other left-to-right shlints originating from the aorta. Circulation 23: 279-285, 1961 6 Benchimol A, Stegall HF, Maroko P, et al: Aortic How velocity in man during arrhythmias measured with the Doppler catheter flowmeter system. Am Heart J 78: 649659, 1969
ANNOUNCEMENTS Postgraduate Course in Bronchoesophagology The department of Laryngology and Bronchoesophagology, Temple University Hospital and School of Medicine will present a Postgraduate Course in Bronchoesophagology, February 2-13, un-
der the direction of Dr. Charles M. Norris. For information, please write: Chevalier Jackson Clinic, Temple University Hospital, 3401 North Broad Street, Philadelphia 19140.
IlKIian Congress on Progress in Vascular Diseases An Indian Congress on Progress in Vascular Diseases will be held under the auspices of the Western India Chapter of the American College of Chest
Physicians in Bombay, India, March 19-21. For information, contact Dr. M. Paul Anand, 4 Narendra Bhuvan, Warden Road, Bombay 400 026, India.
Fourth Annual Taos Lung Disease Symposium The Fourth Annual Taos Lung Disease Symposium will be held at Kachina Lodge, Taos, New Mexico, February 27-29. Sponsor is the New Mexico Chapter,
American Thoracic Society. For information, write the New Mexico Thoracic Society, 216 Truman Avenue NE, Albuquerque 87108
Thrombosis: Current Concepts of Diagnosis and Treatment The American Heart Association Council on Thrombosis will conduct a postgraduate course on Thrombosis in Aspen, Colorado, February 2-4. For information, contact the Office of Continuing Education, University of Colorado Medical School, 4200
CHEST, 68: 6, DECEMBER, 1975
East Ninth Avenue, Denver 80220. Additional sponsors are the Colorado Heart Association, University of Colorado Medical School, and Office of Continuing Education.
PHASIC BLOOD FLOW VELOCITY 821
I
GRAPHIC TECHNIQUES IN CARDIOLOGY
Phasic Blood Flow Velocity at a Potts Anastomosis Measured with the Doppler Flowmeter-Catheter* Alberto Benchimol, A-f.D., F.C.C.P.; Flavio Reich, M.D.; and Kenneth B. Desser, M.D., F.G.G.P.
Sinee
the introduction of Potts' aortopulmonary procedure! for palliative treatment of tetralogy of FalIot, numerous indirect methods have been utilized for evaluation of anastomotic patency.i" The purpose of this paper is to describe phasic, instantaneous, blood-velocity waveforms of a Potts anastomosis in a closed-chest human subject. Figure 1 shows the simultaneously recorded lead 2 of the electrocardiogram, right ventricular pressure, and phasic blood flow velocity within the Potts anastomosis of a 22-year-old man with tetralogy of Fallot, Blood How velocity was measured by introo From
the Institute for Cardiovascular Diseases, Good Samaritan Hospital, Phoenix, Ariz. Supported in part by the E. Nichols and Kim Sigsworth Memorial Funds. Reprint requests: Dr. Benchimol, PO Box 2989, Phoenix 85062
FLOW VELOCITY AT POTT S ANASTOMOSIS
0------------------·-0 FIGURE 1. Simultaneously recorded lead 2 (UI) of electrocardiogram, right ventricular (RV) pressure, and blood How velocity within Potts anastomosis of 22-year-old man with tetralogy of Fallot.
820 BENCHIMOL, REICH, DESSER
duction of a Doppler ultrasonic flowmeter-catheter into the aortic origin" of the anastomosis. Blood velocity was phasic and continuous throughout systole and diastole with a dominant diastolic fraction. Figure 2 shows lead 2 of the electrocardiogram, tricuspid area phonocardiogram, right atrial pressure, and phasic blood velocity when the catheter tip was withdrawn to the aortic origin of the anastomosis. Note systolic and diastolic murmurs which correspond to the major blood velocities recorded during these periods of the cardiac cycle. To our knowledge, this is the first description of phasic Potts anastomotic blood velocity directly measured in an intact, closed-chest human subject. This report emphasizes the feasibility of utilizing a Doppler Howmeter-catheter for evaluating and graphically displaying shunt blood velocity in patients with such an operation.
---
-----------0
FIGURE 2. Simultaneously recorded lead 2 (LII) of electrocardiogram, tricuspid area ( T A) phonocardiogram, right atrial (RA) pressure, and phasic blood flow velocity at aortic origin of Potts anastomosis in 22-year-old man with tetralogy of Fallot.
CHEST, 68: 6, DECEMBER, 1975
REFERENCES
Potts WJ, Smith S, Gibson S: Anastomosis of the aorta to a pulmonary artery: Certain types in congenital heart disease. JAMA 132:627-631, 1946 2 von Bernuth G, Ritter DO, Frye RL, et al: Evaluation of patients with tetralogy of Fallot and Potts anastomosis. Am J Cardiol27 :259-263, 1971 3 Ross RS, Taussig HB, Evans MH: Late hemodynamic complications of anastomotic surgery for the treatment of the tetralogy of Fallot. Circulation 18:553-561, 1958 4 McGaH CJ, Ross RS, Braunwald E: The development of
elevated pulmonary vascular resistance in man following increased pulmonary blood flow from systemic-pulmonary anastomosis. Am J Med 33:201-212.1962 5 Braunwald E, Cornell WP: A simplified technic for the detection of patent ductus arteriosus and other left-to-right shlints originating from the aorta. Circulation 23: 279-285, 1961 6 Benchimol A, Stegall HF, Maroko P, et al: Aortic How velocity in man during arrhythmias measured with the Doppler catheter flowmeter system. Am Heart J 78: 649659, 1969
ANNOUNCEMENTS Postgraduate Course in Bronchoesophagology The department of Laryngology and Bronchoesophagology, Temple University Hospital and School of Medicine will present a Postgraduate Course in Bronchoesophagology, February 2-13, un-
der the direction of Dr. Charles M. Norris. For information, please write: Chevalier Jackson Clinic, Temple University Hospital, 3401 North Broad Street, Philadelphia 19140.
IlKIian Congress on Progress in Vascular Diseases An Indian Congress on Progress in Vascular Diseases will be held under the auspices of the Western India Chapter of the American College of Chest
Physicians in Bombay, India, March 19-21. For information, contact Dr. M. Paul Anand, 4 Narendra Bhuvan, Warden Road, Bombay 400 026, India.
Fourth Annual Taos Lung Disease Symposium The Fourth Annual Taos Lung Disease Symposium will be held at Kachina Lodge, Taos, New Mexico, February 27-29. Sponsor is the New Mexico Chapter,
American Thoracic Society. For information, write the New Mexico Thoracic Society, 216 Truman Avenue NE, Albuquerque 87108
Thrombosis: Current Concepts of Diagnosis and Treatment The American Heart Association Council on Thrombosis will conduct a postgraduate course on Thrombosis in Aspen, Colorado, February 2-4. For information, contact the Office of Continuing Education, University of Colorado Medical School, 4200
CHEST, 68: 6, DECEMBER, 1975
East Ninth Avenue, Denver 80220. Additional sponsors are the Colorado Heart Association, University of Colorado Medical School, and Office of Continuing Education.
PHASIC BLOOD FLOW VELOCITY 821