Functional Anatomy of Tricuspid Regurgitation in Patients with Systemic Right Ventricles

Szymański, Piotr; Klisiewicz, Anna; Lubiszewska, Barbara; Lipczyńska, Magdalena; Konka, Marek; Kuśmierczyk, Mariusz; Hoffmań, Piotr

doi:10.1016/j.echo.2010.01.007

Cited by 18 publications

(16 citation statements)

References 35 publications

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“…21,39 In contrast, several recent studies have successfully utilized RV FAC by echocardiography to monitor RV function in both neonates and children with congenital heart disease, pulmonary hypertension, and sickle cell anemia. 34,35,40-43 Alghamadi et al demonstrated that the RV systolic and diastolic areas measured by echocardiography correlated well with systolic and diastolic volumes by MRI in pediatric patients with repaired Tetralogy of Fallot (TOF). 16 Alkon et al observed that the RV FAC was decreased in children who developed pulmonary arterial hypertension as compared to a control cohort.…”

Section: Discussionmentioning

confidence: 99%

Right Ventricular Function in Preterm and Term Neonates: Reference Values for Right Ventricle Areas and Fractional Area of Change

Levy

Dioneda

Holland

et al. 2015

Journal of the American Society of Echocardiography

101

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Background Right Ventricle fractional area of change (RV FAC) is a quantitative two- dimensional echocardiographic measurement of RV function. RV FAC expresses the percentage change in the RV chamber area between end-diastole (RVEDA) to end-systole (RVESA). The objectives of this study were to determine the maturational (age- and weight- related) changes of RV FAC and RV areas and to establish reference values in healthy preterm and term neonates. Methods A prospective longitudinal study was conducted in 115 preterm infants (23-28 weeks gestational age at birth, 500-1500 gram). RV FAC was measured at 24 hours of age, 72 hours of age, 32 weeks and 36 weeks postmenstrual age (PMA). The maturational patterns of RVEDA, RVESA, and RV FAC were compared to 60 healthy full term infants in a cross sectional study (> 37 weeks, 3.5 +/− 1 kg), who received echocardiograms at birth (n=25) and one month of age (n=35). RVEDA and RVESA were traced in the RV focused apical 4-chamber view, and FAC was calculated using the formula: 100 * [(RVEDA – RVESA)/RVEDA)]. Premature infants that developed chronic lung disease or had a clinically and hemodynamically significant PDA were excluded (n=55) from the reference values. Intra- and inter- observer reproducibility analysis was performed. Results RV FAC ranged from 26% at birth to 35% by 36 weeks PMA in preterm infants (n=60) and increased almost two times faster in the first month of age as compared to healthy term infants (n=60). Similarly, RVEDA and RVESA increased throughout maturation in both term and preterm infants. RV FAC and RV areas correlated with weight (r=0.81, p<0.001), but were independent of gestational age at birth (r=0.3, p=0.45). RVEDA and RVESA correlated with PMA in weeks (r=0.81, p<0.001). RV FAC trended lower in preterm infants with bronchopulmonary dysplasia (p=0.04), but did not correlate to size of PDA (p=0.56). There was no difference in RV FAC based on gender or need for mechanical ventilation. Conclusions This study establishes reference values of RV areas (RVEDA and RVESA) and RV fractional area of change (RV FAC) in healthy term and preterm infants and tracks their maturational changes during postnatal development. These measures increase from birth to 36 weeks PMA, and this is reflective of the postnatal cardiac growth as a contributor to the maturation of cardiac function These measures are also linearly associated with increasing weight throughout maturation. This study suggests that two-dimensional RV FAC can be used as a complementary modality to assess global RV systolic function in neonates and facilitates its incorporation into clinical pediatric and neonatal guidelines.

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Section: Discussionmentioning

confidence: 99%

Right Ventricular Function in Preterm and Term Neonates: Reference Values for Right Ventricle Areas and Fractional Area of Change

Levy

Dioneda

Holland

et al. 2015

Journal of the American Society of Echocardiography

101

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“…134,139 Once an asymptomatic Fontan patient reaches school age and adolescence, on average, biomarker levels drop to the reference normal range. 80,[131][132][133][134] In contrast, adolescents with a Fontan circulation and heart failure demonstrated biomarker levels that are significantly higher than those in patients with a Fontan circulation without heart failure. In these patients, biomarker levels correlate with disease severity as staged by the NYHA or New York University Pediatric Heart Failure scores.…”

Section: Bnp In the Follow-up Of Corrected/palliated Chdmentioning

confidence: 92%

“…151 Different morphological types of functionally univentricular hearts are often associated with important differences in biomarker levels, although it is not yet clear whether there is a significant difference in BNP production between functionally univentricular heart defects of a right ventricular versus left ventricular morphology. 81,132 BNP/NT-proBNP levels usually tend to decrease throughout the successive stages of Fontan palliation. 134,139 Once an asymptomatic Fontan patient reaches school age and adolescence, on average, biomarker levels drop to the reference normal range.…”

Section: Bnp In the Follow-up Of Corrected/palliated Chdmentioning

confidence: 99%

BNP in children with congenital cardiac disease: is there now sufficient evidence for its routine use?

et al. 2015

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Interest in brain natriuretic peptide (BNP) and N-terminal pro-brain natriuretic peptide (NT-proBNP) in the management of children with CHD has increased. There are, however, no current guidelines for their routine use. The aim of this review article is to provide an update on the data regarding the use of BNP/NT-proBNP in the evaluation and surgical treatment of children with CHD. BNP/NT-proBNP levels in children with CHD vary substantially according to age, laboratory assay methods, and the specific haemodynamics associated with the individual congenital heart lesion. The accuracy of BNP/NT-proBNP as supplemental markers in the integrated screening, diagnosis, management, and follow-up of CHD has been established. In particular, the use of BNP/NT-proBNP as a prognostic indicator in paediatric cardiac surgery has been widely demonstrated, as well as its role in the subsequent follow-up of surgical patients. Most of the data, however, are derived from single-centre retrospective studies using multivariable analysis; prospective, randomised clinical trials designed to evaluate the clinical utility and cost-effectiveness of routine BNP/NT-proBNP use in CHD are lacking. The results of well-designed, prospective clinical trials should assist in formulating guidelines and expert consensus recommendations for its use in patients with CHD. Finally, the use of new point-of-care testing methods that use less invasive sampling techniques -capillary blood specimens -may contribute to a more widespread use of the BNP assay, especially in neonates and infants, as well as contribute to the development of screening programmes for CHD using this biomarker.

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“…Further studies are needed to assess the impact of the functional anatomy of systemic tricuspid valve regurgitation. 21 Not only systolic but also diastolic right ventricular dysfunction was revealed by conventional Doppler echocardiographic parameterspulmonary vein blood flow velocities. The tissue Doppler velocitiespeak tricuspid systolic annular velocity and peak tricuspid early diastolic annular velocitywere significantly lower after 6 years, a finding indicating a decrease in systemic right ventricular systolic and diastolic function; however, the systemic right ventricular filling pressures assessed by tissue Doppler parametersratio of transtricuspid early right ventricular filling velocity to early diastolic Doppler tissue imaging velocity of the tricuspid annulus at the lateral position and ratio of transtricuspid early right ventricular filling velocity to early diastolic Doppler tissue imaging mean velocities of the tricuspid annulus at the septal and lateral positionsdid not increase significantly.…”

Section: Discussionmentioning

confidence: 99%

A 6-year follow-up study of adult patients with congenitally corrected transposition

et al. 2014

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The aims of this study were to assess the development of heart failure in patients with congenitally corrected transposition of the great arteries in a medium-term follow-up, to identify the impact of tricuspid regurgitation on the development of heart failure, and to determine the most reliable marker for its identification. The prospective 6-year follow-up study included 19 adult patients. All patients were evaluated clinically by the determination of N-terminal pro-hormone brain natriuretic peptide levels, exercise stress testing, echocardiography magnetic resonance, or CT. Among them, two patients died of heart failure. There was a decline in exercise capacity and systolic systemic ventricular function (p=0.011). Systemic ventricular ejection fraction decreased (48.3±13.7 versus 42.7±12.7%, p=0.001). Tissue Doppler imaging showed a decline in peak tricuspid systolic annular velocity (10.3±2.0 versus 8.3±2.5 cm/second, p=0.032) and peak tricuspid early diastolic annular velocity (14.6±4.3 versus 12.0±4.5 cm/second, p=0.048). The tricuspid regurgitation did not increase significantly. N-terminal pro-hormone brain natriuretic peptide levels increased (127.0 ng/L(82.3-305.8) versus 226.0 ng/L(112.5-753.0), p=0.022). Progressive exercise intolerance in congenitally corrected transposition of the great arteries appears to be driven mainly by a progression in systemic right ventricular dysfunction. Tricuspid regurgitation is likely to play a role, especially in patients with structural abnormalities of the tricuspid valve - Ebstein anomaly. The N-terminal pro-hormone brain natriuretic peptide levels and tissue Doppler parameters appear sensitive in detecting changes over time and may guide management.

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Functional Anatomy of Tricuspid Regurgitation in Patients with Systemic Right Ventricles

Cited by 18 publications

References 35 publications

Right Ventricular Function in Preterm and Term Neonates: Reference Values for Right Ventricle Areas and Fractional Area of Change

Right Ventricular Function in Preterm and Term Neonates: Reference Values for Right Ventricle Areas and Fractional Area of Change

BNP in children with congenital cardiac disease: is there now sufficient evidence for its routine use?

A 6-year follow-up study of adult patients with congenitally corrected transposition

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