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Beyond Doppler: Understanding the Significance of Flow Measurement in Pediatric Cardiology

By Kiele Hayes Rigaud14 Feb 2024

In every cardiac surgeon’s toolbox, there are a variety of instruments and devices that support the intricate work of repairing a heart. Precision is paramount, data is knowledge and, in surgery, knowledge is power. 

When it comes to creating or restoring blood flow during pediatric cardiology procedures, like congenital heart defect repair surgery, flow measurement becomes the critical factor. Without it, a surgeon can only hope that the procedure has been successful because Doppler is often dangerously misleading. (More about that in a moment).

Cardiac output (CO) data is always critical, but especially during pediatric procedures. CO provides immediate, bedside information that a surgeon can use to confirm their clinical impressions and, if needed, make revisions at the most opportune moments. Why close the patient without certainty that flow has been restored? And how can one have certainty without flow measurement?

How Can Cardiac Surgeons Measure Flow?

Doppler technology can provide surgeons with some insight into blood flow during surgery, but Doppler comes with dangerous limitations.

In medical applications, “Doppler” refers to a frequency shift in ultrasound waves caused by the reflection of these waves off of particulate matter (i.e. platelets) in a moving fluid. The velocity of these platelets either compresses the wavefronts (moving against flow) or rarifies them (moving with flow) thereby changing the ultrasound frequency in a manner directly proportional to velocity. In other words, Doppler can provide only a measure of blood velocity (and directionality, by default).

Since all sorts of flow restrictions (kinks, twists, stenoses) can increase velocity while reducing flow, high velocity does not necessarily indicate high flow, and often indicates the exact opposite.

So surgeons need a way to measure true volume flow.

Transit-time ultrasound technology measures average fluid displacement via phase shift  – not frequency change – in the vessel. This full-vessel illumination phase shift converts algorithmically to true volume flow.  

Only transit time ultrasound offers the surgeon hyper-accurate beat-to-beat volume flow measurement during surgery. And for pediatric patients – the smallest and most vulnerable of patients – that high level of detailed accuracy is everything. Nuances in flow during cardiac surgeries for babies and children are worth paying attention to because the details truly matter.

Elevating the Pediatric Surgeon’s Toolbox

Transonic’s flowprobes elevate the pediatric surgeon’s toolbox and fit the needs of smaller patients like children, infants or premature babies. The COnfidence cardiac output flowprobes include sizes down to 4 mm while the Microvascular Flowprobes (MU-Series) is available even smaller – down to 0.7 mm.

No matter what kind of cardiac procedure, from heart transplants to CP bypasses, Transonic's flow measurement solutions give surgeons a critical tool in their toolboxes: the ability to measure true volume flow.

Learn More About Optimizing Pediatric Congenital Heart Defect Repair