BACKGROUND Doppler pressure gradients (PGs) are routinely used as a surrogate for catheter peak-to-peak gradient (PPG) for referring pediatric patients with aortic stenosis (AS), pulmonary stenosis (PS), and coarctation of the aorta (CoA) for intervention but do not always predict the catheter PPG accurately, which results in misclassification of lesion severity. We hypothesized that recovered pressure (RP) accounts for the discrepancy between Doppler PG and catheter PPG. We aimed to study the occurrence of clinically significant RP in AS, PS, and CoA. METHODS Simultaneous Doppler and catheter PGs were prospectively measured in 82 patients (median age, 12.2 months; weight, 7.5 kg) with isolated AS (n = 30), PS (n = 24), and CoA (n = 28), and agreement before and after correcting for RP were analyzed. RP was calculated from a fluid dynamic-based equation. Effects of lesion geometry on the magnitude of RP were analyzed. RESULTS Recovered pressure-corrected Doppler peak instantaneous gradient (PIG) had significantly closer agreement and correlation with the catheter PPG (P < .001) than the uncorrected PIG and mean Doppler gradients. Recovered pressure-corrected Doppler PIG predicted PPG with high specificity and accuracy in all lesions (95% CI, 36%-97% and 85%-100%, respectively, P < .05 for both). RP magnitude was weakly related (r = 0.33 to 0.47) to valve area and inversely related (r = -0.22 to -0.34) to downstream vessel area. CONCLUSIONS Significant RP occurs in congenital AS, PS, and CoA, accounting for misclassification of lesion severity by Doppler PIG. The RP magnitude is at a maximum in mild to moderate stenotic outflow lesions, with small-size downstream vessels causing the most misclassification of lesion severity by Doppler PIG.

中文翻译：

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压力恢复对小儿先天性狭窄流出病变中压力梯度的影响-病变严重程度和几何形状的临床意义：同时多普勒超声心动图和心脏导管相关性研究。

背景技术多普勒压力梯度（PGs）通常用作导管峰-峰梯度（PPG）的替代物，用于转介小儿主动脉瓣狭窄（AS），肺动脉狭窄（PS）和主动脉缩窄（CoA）的患者干预，但并不总是准确地预测导管PPG，这会导致病变严重程度的错误分类。我们假设恢复压力（RP）解释了多普勒PG和导管PPG之间的差异。我们旨在研究在AS，PS和CoA中具有临床意义的RP的发生。方法前瞻性地对82例中位年龄为12.2个月，体重为7.5千克，分别为AS（n = 30），PS（n = 24）和CoA（n = 28）且同意的患者进行了多普勒和导管PG测量校正RP之前和之后进行了分析。RP是从基于流体动力学的方程式计算得出的。分析了病变几何形状对RP大小的影响。结果与未校正的PIG和平均多普勒梯度相比，恢复的压力校正的多普勒峰值瞬时梯度（PIG）与导管PPG的一致性和相关性更显着（P <.001）。恢复的压力校正多普勒PIG预测PPG在所有病变中具有高特异性和准确性（分别为95％CI，36％-97％和85％-100％，两者均P <0.05）。RP大小与瓣膜面积呈弱相关性（r = 0.33至0.47），而与下游血管面积呈负相关性（r = -0.22至-0.34）。结论先天性AS，PS和CoA发生明显的RP，这解释了多普勒PIG对病变严重程度的错误分类。在轻度至中度狭窄流出病变中，RP值最大，