DIAGNOSTIC METHODS CONGENITAL HEART DISEASE Color Doppler detection of multiple ventricular septal defects

Combined two-dimensional and Doppler echocardiography has a high sensitivity and specificity for detection of isolated perimembranous ventricular septal defects. However, muscular or multiple ventricular septal defects may be difficult to diagnose with noninvasive methods, particularly in older children, necessitating angiography for accurate diagnosis. Detection of single and multiple ventricular septal defects with two-dimensional color flow mapping was compared with detection by standard two-dimensional imaging and Doppler. Both techniques were compared with four-chamber left ventricular angiography. Fifty-one patients (age 3 months to 25 years, mean 5.6 years) were studied. Eighteen had solitary ventricular septal defects, 18 had multiple ventricular septal defects, and 15 patients with intact ventricular septum served as a control group. At least one ventricular septal defect was detected by color Doppler and two-dimensional/Doppler methods in all patients with ventricular septal defect proved by angiography with no false positives. In the detection of multiple ventricular septal defects, the sensitivity of color Doppler was 72% and that of two-dimensional/ Doppler was 38% (100% specificity in both). Color Doppler failed to identify multiple ventricular septal defects in five patients (two weighing less than 4 kg and three with reduced pulmonary blood flow). However, no large additional muscular defects were missed by imaging and color Doppler. Color Doppler is useful for the detection of ventricular septal defects and has higher sensitivity than two-dimensional/Doppler for multiple ventricular septal defects. The contribution of color Doppler appears to be in the detection of additional small muscular ventricular septal defects. Circulation 74, No. 6, 1317-1322, 1986 LARGE ventricular septal defects can be detected easily with two-dimensional echocardiography, and small muscular defects have little clinical importance and often close spontaneously. However, when a large ventricular septal defect is present and causes symptoms in an infant, appropriate management currently requires precise anatomic definition of the primary defect and all additional muscular ventricular septal defects, if any. This clinical imperative is encountered frequently in the relatively large group of infants who require early surgery for ventricular septal defect, atrioventricular canal defect, or truncus arteriosus. Combined two-dimensional and Doppler echocarFrom the Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Baylor College of Medicine, and Texas Children's Hospital, Houston. Supported in part by grant RR-00188 from the General Clinical Research Branch of the National Institutes of Health. Dr. Huhta was supported in part by New Investigator Research Award HL31153 from the NHLBI. Address for correspondence: James C. Huhta, M.D., Pediatric Cardiology, 1-253, Texas Children's Hospital, 6621 Fannin St., Houston, TX 77030. Received May 13, 1986; revision accepted Aug. 21, 1986. Vol. 74, No. 6, December 1986 diography has a high sensitivity and specificity for the detection of an isolated perimembranous ventricular septal defect. 1-3 However, multiple ventricular septal defects may be difficult to diagnose with noninvasive methods, necessitating angiographic validation. In this study, the sensitivity and specificity of the new real-time twodimensional/Doppler color flow imaging technique was compared with standard high-resolution two-dimensional/Doppler examinations and angiographic studies in the detection of multiple ventricular septal defects. Two questions were addressed: (1) What is the accuracy of color Doppler in the detection and characterization of multiple ventricular septal defects in children? (2) What are the limitations of the current color Doppler equipment for diagnosis of ventricular septal defect?