Distalward Modification of the Arterial Pulse Wave in Children with Congenital Aortic Stenosis

In 38 children with congenital aortic stenosis (32 valvar, three subvalvar, and three supravalvar: 28 preoperative, ten postoperative), the left ventricular pressure, left ventricular-to-aortic pressure difference and aortic valve area were compared with several components of the central and peripheral arterial pulse waves. In 23 patients, a catheter-tip manometer was used, and in 15, pressure was measured with a regular manometer system and corrected for artifact by resynthesis of pulse waves after harmonic analysis. The severity of the anomaly was not reflected in the central or peripheral pulse pressure, the first derivative of these pressures, mean aortic pressure, pulse wave velocity, or peripheral amplification of pulse waves or of their individual harmonics. While in adults with aortic stenosis, the various pulse wave characteristics correlate with severity, the change in the pulse wave as it travels down the aorta in children is so modified by vascular factors as to be worthless in assessing the severity of the obstruction.