Noninvasive Prediction of Transvalvular Pressure Gradient in Patients with Pulmonary Stenosis by Quantitative Iwo-dimensional Echocardiographic Doppler Studies

Recent studies suggest that maximal Doppler velocities measured within the jets that form downstream from stenotic valves can be used to predict aortic valve gradients. To test whether the Doppler method would be useful for evaluation and management of pediatric patients with right ventricular outflow obstruction, we evaluated pulmonary artery flow before catheterization in 16 children with pulmonary valve stenosis. We used a 3.5-MHz, quantitative, range-gated, two-dimensional, pulsed, echocardiographic Doppler scanner with fast Fourier transform spectral output and a 2.5-MHz phased array with pulsed or continuous-mode Doppler. Peak systolic pulmonary artery flow velocities in the jet were recorded distal to the domed pulmonary valve leaflets in short-axis parasternal echocardiographic views. The pulsed Doppler scanner, because of its limitations for resolving high velocities, could quantify only the mildest stenoses; but, especially with the continuous Doppler technique, a close correlation was found between maximal velocity recorded in the jet and transpulmonary gradients between 11 and 180 mm Hg. A simplified Bernoulli equation (transvalvular gradient = 4 X [maximal velocity]2) proposed by Hatle and Angelsen could be used to predict the gradients found at catheterization with a high degree of accuracy (r = 0.98, SEE = + 7 mm Hg). Our study shows that recording of maximal Doppler jet velocities appears to provide a reliable measure of the severity of valvular pulmonic stenosis.