(Circulation. 1995;92:1860-1865.)
© 1995 American Heart Association, Inc.
Articles |
Contribution of Superior Vena Caval Flow to Total Cardiac Output in Children
A Doppler Echocardiographic Study
Presented in part at the 67th Scientific Session of the American Heart Association, Dallas, Tex, November 13-18, 1994.
From the University of Tennessee School of Medicine, Department of Pediatrics, Division of Cardiology, and the Department of Biostatistics and Epidemiology (K.L.A.), Memphis, Tenn.
Correspondence to Mubadda Salim, MD, Le Bonheur Children's Medical Center, 777 Washington Ave, Ste 215, Memphis, TN 38105.
Background After a cavopulmonary anastomosis, the superior vena caval flow, by virtue of being the effective pulmonary blood flow, is the most important factor influencing the systemic arterial saturation. Determination of the amount of this blood flow will allow a better understanding of the physiology of the circulation after this anastomosis. The purposes of this study were to determine the volumetric flow in the superior vena cava and to evaluate its contribution to the cardiac output as children grow.
Methods and Results Using two-dimensional and Doppler echocardiography, we measured the diameter of and mean flow velocities in the superior venae cavae and the pulmonary arteries of 145 healthy children. We calculated the volumetric flow in each vessel and determined the ratio of superior vena caval flow to total cardiac output. Cardiac output and superior vena caval flow increased with increasing age and body surface area. The superior vena caval flow accounted for 49% of cardiac output in newborn infants. This contribution increased to a maximum of 55% at the age of 2.5 years. Afterward, there was a slow decline in the ratio of superior vena caval–pulmonary arterial flow; it reached the adult value of 35% by 6.6 years of age.
Conclusions There is a maturational change in the superior vena caval contribution to total cardiac output in children. This is most likely related to somatic growth and changes in body segment proportions. This flow maturation may explain the higher systemic saturation in infants compared with older children after cavopulmonary anastomosis.
Key Words: cardiac output • regional blood flow • circulation • echocardiography • hemodynamics
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