Echocardiographic Assessment of Right Atrial Pressure in a Pediatric and Young Adult Population

Abstract

Right atrial pressure (RAP) reflects right-sided cardiac hemodynamics and is useful in management of patients with cardiac and systemic disease. Studies in older adults demonstrated that inferior vena cava (IVC) diameter, IVC collapsibility index, hepatic vein systolic filling fraction (SFF), and right atrial volume (RAV) correlated with mean RAP at catheterization. This study aimed to assess the utility of echocardiographic parameters for assessment of RAP in children and young adults. Patients with pulmonary hypertension or heart transplantation undergoing right heart catheterization were recruited for this prospective observational pilot study. Transthoracic echocardiographic assessment of RAP was performed simultaneously with catheterization. For each parameter, three consecutive cardiac cycles were recorded. Long- and short-axis images of the IVC were obtained. RAV was assessed by area-length and biplane methods. IVC diameters and RAV were indexed to body surface area (BSA)(0.5) and (BSA)(1.4), respectively. Relationships between echocardiographic parameters and mean RAP were correlated using "Pearson's r." Fifty subjects aged 0.3-23 years (median 13, mean 12.3 ± 7 years) were enrolled. Mean RAP correlated modestly with RAV (r = 0.51, p < 0.001). Long-axis IVCmax (r = 0.30, p < 0.05) and tricuspid E wave velocity (r = 0.36, p < 0.01) also correlated with mean RAP. RV free wall tissue Doppler velocities, IVC collapsibility index, and hepatic vein SFF had no relation to mean RAP. In a pediatric and young adult population with pulmonary hypertension or heart transplantation, echocardiographic assessment of RAV and long-axis IVCmax provided a reasonable estimate of mean RAP. IVC collapsibility index and hepatic vein SFF demonstrated no association with mean RAP.

Pulmonary Artery Pressures in School-Age Children Born Prematurely

“…When the IVC diameter was greater than two centimeters, the RAP was estimated as 15 mmHg when the collapsibility was greater than 50% and as 20 mmHg when the collapsibility was less than 50% (10). Measurements of IVC diameter in children have been found to correlate with RAP measured by cardiac catheterization, however the IVC collapsibility had no significant association with RAP (11).…”

Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children

“…Worsening respiratory status, particularly increasing respiratory rate, radiographic evidence of pulmonary edema in an intubated patient, or new or expanding hepatomegaly may be the only clues of evolving fluid overload. Bedside ultrasound may also be helpful to assess fluid overload, as there is emerging evidence to suggest that a "full" inferior vena cava with minimal variation across the respiratory cycle demonstrated on ultrasound indicates a fluid-replete circulation [191].…”

The Role of Echocardiography in Neonates and Pediatric Patients on Extracorporeal Membrane Oxygenation

“…However, this method relies on assumed RA pressure and preserved RV function. For this reason, invasive measurement of the RA pressure should be obtained to accurately estimate PAP ( 48 , 49 ). Alternatively, the PAAT can serve as a reliable parameter and can be easily calculated from the PW spectral of the pulmonary artery.…”