Doppler echocardiographic measurement of pulmonary artery pressure from ductal Doppler velocities in the newborn

Musewe, Norman N.; Poppe, Delores; Smallhorn, Jeffrey F.; Hellman, Jonathan; Whyte, Hilary; Smith, Barry D.; Freedom, Robert M.

doi:10.1016/s0735-1097(10)80076-2

Cited by 101 publications

(52 citation statements)

References 24 publications

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“…In Patients with unidirectional ductal shunting the correlation coefficient was r=0.95(p<0.001; SEE=8mmHg). 4 In the same year Sinder (1990) Our results are in concordance with the results of studies done previously.…”

Section: Discussionsupporting

confidence: 91%

“…It was r=0.96 between end diastolic aortic to main pulmonary pressure gradient and minimum Doppler velocity. 5 While performing similar study in 37 newborns, Musewe et al (1990) found a significant linear correlation between catheter measured SPAP and pulmonary artery systolic pressure derived from ductal Doppler velocities. In Patients with unidirectional ductal shunting the correlation coefficient was r=0.95(p<0.001; SEE=8mmHg).…”

Section: Discussionmentioning

confidence: 86%

“…In the similar way diastolic pressure gradient was obtained from the spectral display. 4,5 Systolic and diastolic blood pressure was measured by sphygmomanometer.…”

Section: Methodsmentioning

confidence: 99%

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Validity of Estimation of Pulmonary artery Pressure Using Continuous wave Doppler Echocardiography in Patient with Patent Ductus Arteriosus (PDA)

et al. 2012

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Introduction:Non invasive evaluation of pulmonary artery pressure is one of the most important concerns in clinical cardiology. Several studies have validated the use of Doppler echocardiography in estimating pulmonary artery pressure noninvasively. 1,2,3 With the use of continuous wave Doppler echocardiography and modified Bernoulli principles, it has been possible to noninvasively estimate pressure gradients across the patent ductus arteriosus. Brachial artery systolic pressure and brachial artery diastolic pressure as measured by sphygmomanometry can be used as an estimation of aortic systolic pressure and aortic diastolic pressure respectively. Continuous wave Doppler echocardiography derived pulmonary artery systolic and diastolic pressure can, therefore, be evaluated by subtracting calculated systolic pressure gradient and diastolic pressure gradient across the patent ductus arteriosus by continuous wave Doppler echocardiography from brachial artery systolic and diastolic pressure, respectively. Subtraction will give the respective pulmonary artery pressure in patients with left-to-right shunt.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 86%

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Validity of Estimation of Pulmonary artery Pressure Using Continuous wave Doppler Echocardiography in Patient with Patent Ductus Arteriosus (PDA)

et al. 2012

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“…To date, echocardiographic studies have been limited to the differentiation of PPHN from congenital heart disease (13), the assessment of atrial shunting (14), and the development of indirect M-mode indices for early identification of infants with PPHN (15). More recent Doppler methods include the use of acceleration time (16), the mean velocity of pulmonary blood flow (17), ductus venosus blood velocity (18), velocity across the PDA (19,20), and regurgitant jet velocity across the tricuspid valve (16,20,21). Estimation of the systolic PAP from the peak velocity of the TR jet is the most accurate method and is easy to measure (16,21), but it is not always available.…”

Section: Discussionmentioning

confidence: 99%

Usefulness of a New Doppler Index for Assessing Both Ventricular Functions and Pulmonary Circulation in Newborn Piglet With Hypoxic Pulmonary Hypertension

Sugiura¹,

Suzuki

Hussein³

et al. 2003

Pediatr Res

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Persistent pulmonary hypertension of the newborn is a clinical syndrome associated with a variety of cardiopulmonary diseases. Serial evaluation of pulmonary circulation and cardiac function is important, but available imaging techniques have been limited. A new Doppler index combining systolic and diastolic time intervals (the Tei index, which is a simple and noninvasive measurement) has been reported to be useful for the assessment of global cardiac function in adults and children. The purpose of this study was to test the effectiveness of the Tei index in prospectively assessing ventricular function and pulmonary circulation in a newborn piglet model with hypoxic pulmonary hypertension. One-day-old piglets (1.1-1.6 kg) were intubated and prepared for the experiments under room air and hypoxia. A complete two-dimensional Doppler echocardiographic examination was performed. Common hemodynamic variables were measured continuously throughout the study. The right ventricle (RV) Tei index under hypoxia (fraction of inspired oxygen ϭ 0.10) was significantly higher than the value under air ventilation (medians, 0.38 versus 0.56; p Ͻ 0.05). Moreover, there was a significant correlation between RV Tei index and mean pulmonary artery pressure and positive linear correlation between individual changes in RV Tei index and changes in mPAP (r 2 ϭ 0.799, p Ͻ 0.05). We conclude that the Tei index is useful for assessing the function of the RV and the left ventricle and pulmonary circulation in a newborn piglet model with hypoxic pulmonary hypertension. These results suggest that the Tei index will become an objective method of assessing patients with persistent pulmonary hypertension of the newborn. Abbreviations PPHN, persistent pulmonary hypertension of the newborn RV, right ventricle LV, left ventricle PAP, pulmonary artery pressure HR, heart rate mPAP, mean pulmonary artery pressure SBP, systemic blood pressure mSBP, mean systemic blood pressure CVP, central venous pressure TR, tricuspid regurgitation PDA, patent ductus arteriosus PFO, patent foramen ovale ROC, receiver-operating characteristic RVPEP/RVEP, right ventricular preejection period/right ventricular ejection period Persistent pulmonary hypertension of the newborn (PPHN) is a clinical syndrome associated with a variety of cardiopulmonary diseases. Infants with PPHN are severely hypoxemic owing to a sustained elevation in pulmonary vascular resistance [and the resulting elevated pulmonary artery pressure (PAP)], with associated extrapulmonary shunting (1, 2). PPHN can be associated with a myriad of clinical conditions, such as meconium aspiration, asphyxia, and heart failure. Thus, serial evaluation of pulmonary circulation and cardiac function is important to assess accurately the clinical course, the efficacy of treatment, and the prognosis. The available imaging techniques have been limited, but a new Doppler echocardiographic index combining systolic and diastolic time intervals (the Tei index) has been reported to be useful for the assessment of global funct...

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“…The pressure gradient (PG) driving blood through an orifice can be calculated according to the simplified Bernoulli equation as PG54V 2 (mmHg), where V represents the peak jet velocity, not accounting for orifice geometry and blood viscosity [16,18]. Consequently, the peak jet velocity of pulmonary insufficiency [19] as well as peak flow velocities across a ventricular septal defect [20,21] or patent ductus arteriosus [22] allow for calculations of Ppa. However, tricuspid valve regurgitant jet is the most widely used for this purpose [23].…”

Section: Diagnostic Value Of Echocardiography and Its Role In Screenimentioning

confidence: 99%

The role of echocardiography in the diagnosis and management of patients with pulmonary hypertension

Habib¹,

Torbicki²

2010

European Respiratory Review

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Pulmonary hypertension (PH) is defined as an increased mean pulmonary artery pressure (Ppa) .25 mmHg at rest as assessed by right heart catheterisation (RHC). However, this technique is invasive and noninvasive alternatives are desirable for early diagnosis of PH. Although estimation of systolic pulmonary arterial pressure is easily obtained using Doppler echocardiography, cases of under-and over-estimations are not rare and direct measurement of Ppa is not possible using this method. Therefore, echocardiography should be considered as a tool for assessment of the likelihood rather than the definite presence or absence of PH. Transthoracic echocardiography may be useful for noninvasive screening of patients at risk of PH. On the basis of an echocardiographic assessment, patients showing signs suggestive of PH can be referred for a confirmatory RHC. A number of variables measured during echocardiography reflect the morphological and functional consequences of PH and have prognostic value. The presence of pericardial effusion, reduced tricuspid annular plane excursion and right atrial enlargement are associated with a poorer prognosis. Echocardiography is also an important procedure for monitoring the response of patients to therapy, and is recommended 3-4 months after initiation of, or a change in, therapy. Echocardiographic assessment as part of a goal-oriented approach to therapy is essential for the effective management of PH patients.

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Doppler echocardiographic measurement of pulmonary artery pressure from ductal Doppler velocities in the newborn

Cited by 101 publications

References 24 publications

Validity of Estimation of Pulmonary artery Pressure Using Continuous wave Doppler Echocardiography in Patient with Patent Ductus Arteriosus (PDA)

Validity of Estimation of Pulmonary artery Pressure Using Continuous wave Doppler Echocardiography in Patient with Patent Ductus Arteriosus (PDA)

Usefulness of a New Doppler Index for Assessing Both Ventricular Functions and Pulmonary Circulation in Newborn Piglet With Hypoxic Pulmonary Hypertension

The role of echocardiography in the diagnosis and management of patients with pulmonary hypertension

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