Method of Recording Reverse and Delayed Turbulent Blood Flow in an Obese Pediatric Patient with Congenital Aortic Stenosis

Introduction: The combination of pediatric obesity and congenital aortic stenosis (AS) may be clinically challenging. Many obese patients have technically difficult echocardiograms with poor acoustic windows. However, the suprasternal notch (SSN) may provide adequate images in these patients. By combining echocardiography with duplex sonography, the flow characteristics of turbulent blood flow (TBF) are shown in this patient. Case: An asymptomatic 12-year-old female presented in our outpatient clinic for routine surveillance of moderate congenital AS. As a neonate the patient required balloon aortic valvotomy for critical aortic stenosis. The body surface area was 2.1 m2 with a body mass index of 34.6 kg/m2. Reverse TBF was recorded along the medial wall of the ascending aorta (AO). Delayed TBF was recorded in the distal ascending AO, proximal left common carotid artery (LCC), and the proximal thoracic AO. The peak velocity of TBF in the proximal LCC was 3.9 m/sec and a 560% drop in peak velocity was shown between the proximal and distal LCC. Discussion: Pediatric obesity is an important consideration in congenital AS. Up to 27% of patients with congenital heart disease may be affected. The study of TBF may show changes that can lead to low velocity carotid blood flow. Conclusion: Recordings of TBF are feasible, even in some obese and technically difficult patients. The onset of reverse TBF, delayed TBF, and low velocity carotid blood flow could be indicators of TBF severity. Severe turbulence could be an indicator of long-term mortality.