Automated 3-Dimensional Single-Beat Real-Time Volume Colour Flow Doppler Echocardiography in Children: A Validation Study of Right and Left Heart Flows

Background: Novel quantification of stroke volume according to mitral inflow and aortic outflow using automated real-time 3-dimensional volume colour flow Doppler echocardiography (3D-RT-VCFDE) is more accurate than 2-dimensional echocardiography and has excellent correlation with cardiacmagnetic resonance imaging-based flows in adults. This technology is applied for the first time to the right heart and in children. Methods: 3D-RT-VCFDE was performed in 61 image sets of flow through the aortic (AV), mitral (MV), pulmonary (PV), and tricuspid (TV) valves of 34 children. These were compared with stroke volumes of the right (RV) and left (LV) ventricles and ratio of pulmonary to systemic blood flow determined using the Fick method in 31 children with atrial shunts. Results: The mean age was 8.0 +/- 3.3 years, and the mean weight was 27.8 +/- 10.0 kg. The mean temporal resolution for flow analyses was >= 22 volumes per second. In conditions with no shunt, the correlations were: AV with MV flows (r = 0.98), PV with TV flows (r = 0.96), RV stroke volume with PV flow (r = 0.95), and with TV flow (r = 0.93), LV stroke volume with AV flow (r = 0.87), and with MV flow (r = 0.89). Fick ratio of pulmonary to systemic blood flow correlations were: PV/AV ratio (r = 0.84), TV/MV ratio (r = 0.87), and RV/LV ratio (r = 0.70). Conclusions: Stroke volume determined using automated 3D-RT-VCFDE is feasible in children and in the right side of the heart. This technique potentially provides a noninvasive alternative to historically invasively acquired hemodynamic data and to cardiac magnetic resonance imaging.