Abstract
Spontaneous retinal venous pulsations (SRVP) are assessed as a clinical marker for patients with ophthalmic or neurological disorders. The pulsations are influenced by intraocular pressure (IOP), cerebrospinal fluid pressure (CSFp), and retinal venous pressure (RVP). However, little is known about the effect of cyanosis with polycythemia, a common finding in adults with complex congenital heart disease (CHD), on SRVP. This study investigated 11 subjects with long-standing cyanosis secondary to CHD and 11 control subjects to determine if there were measurable differences in resting pulsatility for a given IOP level. Intraocular pressure was measured using Goldman tonometry, and dynamic SRVP was recorded noninvasively using a retinal vessel imaging system. Peak amplitude of SRVP at each cardiac cycle was measured and compared with IOP. Heart rate was also monitored during the tests. Results show that for a similar baseline IOP, SRVP amplitudes are significantly lower in cyanotic patients compared with normal subjects (P < 0.0001). This may be explained by an increased RVP or high CSFp in these patients. Mean venous diameter is also significantly higher in cyanotic patients (P < 0.01), but no significant relationship was found between SRVP or diameter with blood parameters.
Similar content being viewed by others
References
Kohner EM, Allen EM, Saunders KB, Emery VM, Pallis C (1967) Electroencephalogram and retinal vessels in congenital cyanotic heart disease before and after surgery. Br Med J 4:207–210
Petersen RA, Rosenthal A (1972) Retinopathy and papilledema in cyanotic heart disease. Pediatrics 49:243–249
Crowe RJ, Kohner EM, Owen SJ, Robinson DM (1969) The retinal vessels in congenital heart disease. Med Biol 19:95–99
Johns KJ, Johns JA, Feman SS (1991) Retinal vascular abnormalities in patients with coarctation of the aorta. Arch Ophthalmol 109:1266–1268
Mansour AM, Bitar FF, Traboulisi EI, Kassak KM, Obeid MY, Megarbane A, Salti HI (2005) Ocular pathology in congenital heart disease. Eye 19:29–34
Vander Veen DK, Pasquale LR, Fulton AB (1997) Central retinal vein occlusion in a young child with cyanotic heart disease. Arch Ophthalmol 115:1077
Guorong L, Shaohui L, Peng J, Huitong L, Boyi L, Wanhong X, Liya L (2009) Cerebrovascular blood flow dynamic changes in foetuses with congenital heart disease. Fetal Diagn Ther 25:167–172
Suda K, Matsumura M, Miyanish S, Uehara K, Sugita T, Matsumoto M (2004) Increased vascular endothelial growth factor in patients with cyanotic congenital heart diseases may not be normalized after a Fontan type operation. Ann Thorac Surg 78(3):942–946
Amoozgar H, Behniafard N, Borzoee M, Ajami GH (2008) Correlation between peripheral and central venous pressures in children with congenital heart disease. Pediatr Cardiol 29:281–284
Morgan WH, Hazelton ML, Azar SL (2004) Retinal venous pulsation in glaucoma and glaucoma suspects. Ophthalmology 111:1489–1494
Levine DN (1998) Spontaneous pulsation of the retinal veins. Microvasc Res 56:154–165
Jonas JB (2005) Retinal venous pulsation and glaucoma. Ophthalmology 112:948–949
Kahn EA, Cherry GR (1950) The clinical importance of spontaneous retinal venous pulsation. Med Bull 10:305–308
Levin BE (1978) The clinical significance of spontaneous pulsations of the retinal vein. Arch Neurol 1:37–40
Baurmann M (1925) On the origin and clinical significance of retinal venous pulse. Zusammenkunft Deutschen Ophthalmol 45:53–59
Golzan SM, Graham SL, Leaney J, Avolio A (2011) Dynamic association between intraocular pressure and spontaneous pulsations of retinal veins. Curr Eye Res 36(1):53–59
Nagy F (1950) Changes in the fundus caused by polycythaemia. Br J Ophthalmol 34(6):380–384
Baty L, Russo P, Tobias JD (2008) Measurement of central venous pressure from a peripheral intravenous catheter following cardiopulmonary bypass in infants and children with congenital heart disease. Intensive Care Med 23(2):136–142
Fu ER (1996) Bilateral corkscrew episcleral veins from tricuspid incompetence. Am J Ophthalmol 122:577–578
Horb ME, Thomsen GH (1999) Tbx5 is essential for heart development. Development 126:1739–1751
Hayashi T, Anegawa S, Torigoe R (1991) Relationship between cardiovascular circulation and intracranial pressure—analyses of polygraphic recordings during cardiac surgery in congenital heart diseases. No To Shinkei 43(5):473–482
Ammash N, Warnes CA (1996) Cerebrovascular events in adult patients with cyanotic congenital heart disease. Am Coll Cardiol 28(3):768–772
Acknowledgments
This study was supported in part by an unrestricted research grant from Novartis Australia. S.M. Golzan was supported by a Macquarie University Research Excellence Scholarship.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Mojtaba Golzan, S., Leaney, J., Cordina, R. et al. Spontaneous retinal venous pulsatility in patients with cyanotic congenital heart disease. Heart Vessels 27, 618–623 (2012). https://doi.org/10.1007/s00380-011-0201-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00380-011-0201-x