The significance of carotid bruits in children: transmitted murmur or vascular origin, studies by pulsed Doppler ultrasound.

Forty-four youngsters with precordial murmurs and carotid bruits were evaluated clinically and independently, using pulsed Doppler ultrasound. The precordial murmur was evaluated with M-mode echocardiography combined with Doppler flow evaluation, and the carotid bruit was evaluated with peripheral vascular sector scan with Doppler flow evaluation. These ultrasonic techniques can identify abnormal blood flow at anatomic sites such as the aortic valve and in the carotid arteries. The patients had no symptoms and their condition, except for six, was mild enough that catheterization was not indicated. The clinical diagnosis of aortic stenosis was made in 30 children, and nine were thought to have no heart disease. On the basis of the ultrasonic examinations, 28 patients were diagnosed as having aortic stenosis and seven subjects had no intracardiac turbulence. However, there was disagreement in 14 instances; four of the six clinical "normals" were found to have aortic stenosis by pulsed Doppler echocardiography; six patients diagnosed as having mild aortic stenosis on a clinical basis were found to have no aortic abnormality. The results confirm that aortic stenosis usually presents as a murmur maximal in the aortic area, which is associated with a carotid bruit. Unfortunately, in at least one-fourth of the cases the murmur was not maximal at the aortic area, and a carotid bruit was found in several normal subjects. Since the consequences of over- or under-diagnosis of aortic stenosis are substantial, careful thought should be given to the differential diagnosis, and if possible, pulsed Doppler echocardiography should be utilized for a definitive statement of aortic valve-induced turbulence.