Aortic arch recoarctation after the norwood stage I palliation: The comparative accuracy of blood pressure cuff and echocardiographic doppler gradients in detecting significant obstruction

Priya Sekar, William L. Border, Thomas R. Kimball, Russel Hirsch, Peter B. Manning, Philip R. Khoury, Robert H. Beekman

Research output: Contribution to journalArticle

Abstract

Objective. Aortic arch recoarctation is responsible for significant morbidity and mortality after the Norwood Stage I procedure. Cuff blood pressure (BP) gradients and echocardiographic Doppler gradients are routinely used as noninvasive screening tests for early detection, but accuracy has not been systematically tested. We sought to evaluate the ability of cuff BP and Doppler gradients, measured at routine outpatient clinic visits, to predict significant arch obstruction in single ventricle patients after the Norwood operation. Design. Consecutive patients who underwent Norwood operation at our institution were identified retrospectively. Cuff and echocardiographic gradients measured prior to the pre-Glenn catheterization were compared to peak-to-peak systolic neoaortic arch gradients obtained at catheterization. Statistical analyses, including Receiver Operator Characteristic (ROC) curves, were performed using different cutpoints for cuff and echocardiographic gradients, evaluating their ability to predict a clinically significant catheter gradient. Results. Data were obtained in 68 patients. Echocardiographic gradient cutpoints were more sensitive but less specific than cuff BP gradient cutpoints at detecting a catheter gradient ≥ 10 mm Hg. Echo gradients ≥ 20 mm Hg showed 85% sensitivity and 95% specificity in detecting a systolic catheter gradient ≥ 10 mm Hg. Conclusion. Echocardiographic Doppler outperforms cuff BP as a sensitive noninvasive screening tool for early detection of significant arch obstruction in infants after the Norwood operation.

Original languageEnglish (US)
Pages (from-to)440-447
Number of pages8
JournalCongenital Heart Disease
Volume4
Issue number6
DOIs
StatePublished - 2009
Externally publishedYes

Fingerprint

Norwood Procedures
Thoracic Aorta
Blood Pressure
Catheters
Catheterization
Ambulatory Care
Ambulatory Care Facilities
Morbidity
Sensitivity and Specificity
Mortality

Keywords

  • Norwood
  • Recoarctation
  • Screening

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Pediatrics, Perinatology, and Child Health
  • Surgery
  • Radiology Nuclear Medicine and imaging

Cite this

Aortic arch recoarctation after the norwood stage I palliation : The comparative accuracy of blood pressure cuff and echocardiographic doppler gradients in detecting significant obstruction. / Sekar, Priya; Border, William L.; Kimball, Thomas R.; Hirsch, Russel; Manning, Peter B.; Khoury, Philip R.; Beekman, Robert H.

In: Congenital Heart Disease, Vol. 4, No. 6, 2009, p. 440-447.

Research output: Contribution to journalArticle

Sekar, Priya ; Border, William L. ; Kimball, Thomas R. ; Hirsch, Russel ; Manning, Peter B. ; Khoury, Philip R. ; Beekman, Robert H. / Aortic arch recoarctation after the norwood stage I palliation : The comparative accuracy of blood pressure cuff and echocardiographic doppler gradients in detecting significant obstruction. In: Congenital Heart Disease. 2009 ; Vol. 4, No. 6. pp. 440-447.
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abstract = "Objective. Aortic arch recoarctation is responsible for significant morbidity and mortality after the Norwood Stage I procedure. Cuff blood pressure (BP) gradients and echocardiographic Doppler gradients are routinely used as noninvasive screening tests for early detection, but accuracy has not been systematically tested. We sought to evaluate the ability of cuff BP and Doppler gradients, measured at routine outpatient clinic visits, to predict significant arch obstruction in single ventricle patients after the Norwood operation. Design. Consecutive patients who underwent Norwood operation at our institution were identified retrospectively. Cuff and echocardiographic gradients measured prior to the pre-Glenn catheterization were compared to peak-to-peak systolic neoaortic arch gradients obtained at catheterization. Statistical analyses, including Receiver Operator Characteristic (ROC) curves, were performed using different cutpoints for cuff and echocardiographic gradients, evaluating their ability to predict a clinically significant catheter gradient. Results. Data were obtained in 68 patients. Echocardiographic gradient cutpoints were more sensitive but less specific than cuff BP gradient cutpoints at detecting a catheter gradient ≥ 10 mm Hg. Echo gradients ≥ 20 mm Hg showed 85{\%} sensitivity and 95{\%} specificity in detecting a systolic catheter gradient ≥ 10 mm Hg. Conclusion. Echocardiographic Doppler outperforms cuff BP as a sensitive noninvasive screening tool for early detection of significant arch obstruction in infants after the Norwood operation.",
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N2 - Objective. Aortic arch recoarctation is responsible for significant morbidity and mortality after the Norwood Stage I procedure. Cuff blood pressure (BP) gradients and echocardiographic Doppler gradients are routinely used as noninvasive screening tests for early detection, but accuracy has not been systematically tested. We sought to evaluate the ability of cuff BP and Doppler gradients, measured at routine outpatient clinic visits, to predict significant arch obstruction in single ventricle patients after the Norwood operation. Design. Consecutive patients who underwent Norwood operation at our institution were identified retrospectively. Cuff and echocardiographic gradients measured prior to the pre-Glenn catheterization were compared to peak-to-peak systolic neoaortic arch gradients obtained at catheterization. Statistical analyses, including Receiver Operator Characteristic (ROC) curves, were performed using different cutpoints for cuff and echocardiographic gradients, evaluating their ability to predict a clinically significant catheter gradient. Results. Data were obtained in 68 patients. Echocardiographic gradient cutpoints were more sensitive but less specific than cuff BP gradient cutpoints at detecting a catheter gradient ≥ 10 mm Hg. Echo gradients ≥ 20 mm Hg showed 85% sensitivity and 95% specificity in detecting a systolic catheter gradient ≥ 10 mm Hg. Conclusion. Echocardiographic Doppler outperforms cuff BP as a sensitive noninvasive screening tool for early detection of significant arch obstruction in infants after the Norwood operation.

AB - Objective. Aortic arch recoarctation is responsible for significant morbidity and mortality after the Norwood Stage I procedure. Cuff blood pressure (BP) gradients and echocardiographic Doppler gradients are routinely used as noninvasive screening tests for early detection, but accuracy has not been systematically tested. We sought to evaluate the ability of cuff BP and Doppler gradients, measured at routine outpatient clinic visits, to predict significant arch obstruction in single ventricle patients after the Norwood operation. Design. Consecutive patients who underwent Norwood operation at our institution were identified retrospectively. Cuff and echocardiographic gradients measured prior to the pre-Glenn catheterization were compared to peak-to-peak systolic neoaortic arch gradients obtained at catheterization. Statistical analyses, including Receiver Operator Characteristic (ROC) curves, were performed using different cutpoints for cuff and echocardiographic gradients, evaluating their ability to predict a clinically significant catheter gradient. Results. Data were obtained in 68 patients. Echocardiographic gradient cutpoints were more sensitive but less specific than cuff BP gradient cutpoints at detecting a catheter gradient ≥ 10 mm Hg. Echo gradients ≥ 20 mm Hg showed 85% sensitivity and 95% specificity in detecting a systolic catheter gradient ≥ 10 mm Hg. Conclusion. Echocardiographic Doppler outperforms cuff BP as a sensitive noninvasive screening tool for early detection of significant arch obstruction in infants after the Norwood operation.

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