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(Circulation. 2001;104:908.)
© 2001 American Heart Association, Inc.

Clinical Investigation and Reports

Development of A Noninvasive Ultrasound Color M-Mode Means of Estimating Pulmonary Vascular Resistance in Pediatric Pulmonary Hypertension

Mathematical Analysis, In Vitro Validation, and Preliminary Clinical Studies

Robin Shandas, PhD; Craig Weinberg, MSc; D. Dunbar Ivy, MD; Ewen Nicol, BSc; Curt G. DeGroff, MD; Jean Hertzberg, PhD; Lilliam Valdes-Cruz, MD

From the Children’s Hospital/University of Colorado Health Sciences Center, Denver, Co (R.S., D.D.I., E.N., C.G.D., L.V.-C.), and the Department of Mechanical Engineering, University of Colorado, Boulder, Co (R.S., C.W., J.H.).

Correspondence to Robin Shandas, PhD, Cardiovascular Flow Research Laboratory, The Children’s Hospital, 1056 E. 19th Ave, B-100, Denver, CO 80219. E-mail shandas.robin{at}tchden.org

Background—— Accurate determination of pulmonary vascular resistance (PVR) is an important component in the evaluation and treatment of pediatric patients with pulmonary hypertension. We developed a novel technique, based on the concept of flow propagation, to estimate PVR noninvasively. The hypothesis is that changes in PVR cause changes in the velocity propagation (Vel_prop) within the main pulmonary artery and that Vel_prop can be quantified using color M-mode imaging.

Methods and Results—— We tested the hypothesis using mathematical modeling, in vitro experiments, and preliminary clinical studies. The mathematical model showed that pressure and velocity tracings are closely correlated in time and that 6 to 18 ms time resolution was needed to resolve propagation times within typical main pulmonary artery lengths (2 to 5 cm). The in vitro experiments demonstrated that it was feasible to use color M-mode to measure Vel_prop and that Vel_prop correlated well with downstream resistance [y=(-1.01x)+22.77; R=0.96]. The method was then evaluated on patients undergoing acute pulmonary reactivity testing (n=22 measurements). Good correlation between Vel_prop and PVR was found [y=(-1.71x)+26.0; R=0.90; SEE=2.41].

Conclusion—— This newly developed method promises to be useful in the noninvasive evaluation of adults and children with pulmonary hypertension.

Key Words: hypertension, pulmonary • echocardiography • heart defects, congenital

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