Angiocardiographic Measurements in Congenital Heart Disease in Infancy and Childhood

Construction of Femoral Vessel Nomograms for Planning Cardiac Interventional Procedures in Children 0-4 Years Old

The objectives of this study were to construct femoral artery (FA) and femoral vein (FV) nomograms in children aged 0-4 years and to construct probability curves for the occurrence of arterial access complications based on the size of the FA. The FV and FA are commonly accessed during cardiac catheterizations in children with congenital heart diseases (CHD). However, nomograms for vessel dimensions based on child's age or size are not available. This knowledge may be helpful for interventional planning. A prospective study was performed on 400 children (age 0-4 years) with CHD undergoing cardiac catheterizations over a 3-year period. Ultrasound evaluation of the right and left FA and FV was performed under anesthesia prior to vascular access. Regression modeling was applied to derive nomograms based on quantile polynomial regression, which yielded good fit to the data judged by R-squared. GAMLSS transformation method was used to formulate smoothed percentiles. A separate prospective evaluation of FA to determine the size below which loss of pulse (LOP) are likely to occur was performed. Nomograms for FA and FV diameter and cross-sectional area against age and body surface area and probability curves for FA LOP were constructed. It is now possible to examine ultrasound-based normal sizes of femoral vein and artery in children 0-4 years of age. Femoral vessel nomograms and LOP probability curves may help with interventional planning. Future studies with larger sample size, including children of other ages may be useful.

Measurements of central blood vessels in infants and children: normal values

In order to provide physicians interpreting vascular radiographic studies with normal data regarding central blood vessel size in children and to facilitate the design and adaptation of intravascular devices for pediatric use, we measured lengths and diameters of central blood vessels in 141 radiographic studies in 136 children. The diameters of the following vessels were determined: right and left internal jugular veins and common carotid arteries; the inferior vena cava and the descending thoracic aorta; right and left iliac veins; and right and left femoral veins and arteries. In addition, the lengths of the inferior vena cava and the descending aorta were also determined. Blood vessel dimensions were highly correlated with age, height, weight, and body surface area. The linear regression equations for each measured dimension against age, weight, height, and surface area are provided, along with a table of predicted vessel size as a function of age.

Aortic diameters in infants and young children: normative angiographic data

Cineangiographic measurements, in the left anterior oblique view, of the diameter of the ascending aorta, arch, isthmus, postisthmic region, and descending aorta were made in 18 infants and children with no detectable cardiac anomaly and in 47 with congenital heart disease that did not involve the aorta. Results are tabulated according to age and body surface area. They provide normative data from which variations from usual can be judged.

Intra-aortic balloon pumping in infants and children

From November 1981 to November 1982, intra-aortic balloon pumping (IABP) was used after surgery in eight patients who were from 6 weeks to 6 years old and who weighed from 4.2 to 16.2 kg. In seven patients, specially constructed intra-aortic balloons with 2.5 and 5.0 ml volumes mounted on No. 5F catheters were used. In the largest and oldest patient, a two-chamber 10 ml balloon was used. The pumping module used was the Datascope System 82. Effective diastolic augmentation of arterial pressure was accomplished in seven of the eight patients and suprasystolic diastolic augmentation was accomplished in four. The two youngest and smallest patients are the only long-term survivors. There were two short-term survivors who died 5 and 10 days after successful IABP. In only one patient was there no appreciable effect of IABP. Miniaturization of the equipment has permitted IABP to be used effectively in pediatric patients.

Dimensions of the great arteries, semilunar valve roots, and right ventricular outflow tract during growth: normative angiocardiographic data

Systolic and diastolic diameters of the right and left pulmonary arteries (RPAD, LPAD), descending thoracic aorta (DTAD), right ventricular infundibulum (RVID), and pulmonary and aortic valve roots at the proximal, commissural and distal levels were estimated from angiocardiograms in 24 infants, children, and adolescents without heart disease, and correlated with body surface area (BSA), stroke volume (SV), cardiac output (CO), and ventricular volumes. The relationships between cardiovascular diameters and BSA were better expressed by a power function than by the other functions tried. We obtained different exponents for pulmonary and aortic valve annuli and the more distally measured great arteries (RPAD, LPAD, and DTAD), suggesting different growth patterns. The right ventricular infundibular shortening fraction (RVISF) was weakly correlated with BSA (r = -0.328), and the values obtained indicated constancy during normal growth. There was a direct proportional relationship between the pulmonary valve annulus diameter and the cube root of the right ventricular volume (r = 0.952), as well as between SV and cross-sections of the right pulmonary artery (RPAC; r = 0.916), left pulmonary artery (LPAC; r = 0.878) and descending thoracic aorta (r = 0.962). RPAC and LPAC were strongly correlated (r = 0.940), the RPAC being significantly larger than the LPAC.

The ascending aorta in aortic stenosis

Dilatation of the ascending aorta, a frequently reported sign of aortic stenosis, was assessed in 47 patients for whom aortic angiograms has been recorded. Twenty-eight of the patients had rheumatic valvar disease and 19 had congenital aortic stenosis. A simple ratio between the maximal width of the mid-ascending aorta and the width of the aortic root was calculated. Patients with congenital aortic stenosis had significantly greater supravalvar aortic dilatation than did those with rheumatic aortic valve involvement. There was no correlation between the pressure difference across the aortic valve and degree of dilatation of the ascending aorta.