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Echocardiographic and Doppler evaluation of the aortic arch and brachiocephalic vessels in cerebral and systemic arteriovenous fistulas

1988; Elsevier BV; Volume: 12; Issue: 6 Linguagem: Inglês

10.1016/s0735-1097(88)80021-4

1558-3597

Norman N. Musewe, Jeffrey F. Smallhorn, Patricia E. Burrows, T Izukawa, Robert M. Freedom,

Coronary Artery Anomalies

Congenital arteriovenous fistulas presenting in the newborn period pose difficult diagnostic problems and simulate structural heart disease. Angiocardiography, when performed, demonstrates enlarged brachiocephalic vessels and rapid cerebral venous return. The value of echocardiographic imaging and measurement of the aortic arch and brachiocephalic vessels, and evaluation of the Doppler flow profile in these vessels as a means of making a rapid diagnosis of cerebral or thoracic arteriovenous fistula, was therefore assessed in 10 infants with these diagnoses seen over a 4 year period (1983 to 1987). Twenty-nine infants (median age 6 weeks) undergoing two-dimensional echocardiography but with no significant lesions were prospectively selected as controls. Nine of the 10 patients had congestive heart failure at presentation (mean age 2 days). A cranial bruit was heard in three and arteriovenous fistula was suspected in five patients. Aortic arch segments and brachiocephalic vessel dimensions expressed as ratios of the abdominal aorta showed significantly larger values in patients for the ascending aorta (p = 0.01), innominate artery (p < 0.001), right and left subclavian arteries (p < 0.001) and left common carotid artery (p < 0.05). The thoracic descending aorta was, however, significantly smaller in patients (p < 0.002). Retrograde diastolic Doppler flow in the descending aorta proximal to the ductus arteriosus and anterograde diastolic flow with a mean spectral flow-time integral 27% of systolic were present in patients only, whereas Doppler diastolic flow in brachiocephalic vessels, present in 5 of 29 control infants, was <15% of systolic flow and not accompanied by dilation of these vessels. The combination of one or more dilated brachiocephalic vessels, diastolic retrograde flow in the isthmus and diastolic anterograde flow in the dilated vessels is useful in reaching a diagnosis of cerebral or thoracic arteriovenous fistula, and should aid in expediting rapid definitive cerebral ultrasound and arteriography for confirmation.