Quantitative Assessment of Pulmonary Insufficiency by Doppler Echocardiography in Patients with Adult Congenital Heart Disease

Yang, Hua; Pu, Min; Chambers, Charles E.; Weber, Howard S.; Myers, John L.; Davidson, William R.

doi:10.1016/j.echo.2007.06.003

Cited by 23 publications

(28 citation statements)

References 27 publications

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“…24, 25, 26, 31, 32 A number of measurements have been attempted including the Pulmonary Regurgitant Index, and in adults, the width of the vena contracta. 18, 24 However, such measurements have not proven reproducible and are not relevant to the repaired patient with TOF and a disrupted pulmonary valve.…”

Section: Discussionmentioning

confidence: 99%

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Quantifying Pulmonary Regurgitation and Right Ventricular Function in Surgically Repaired Tetralogy of Fallot

Mercer‐Rosa

Yang

Kutty

et al. 2012

Circ: Cardiovascular Imaging

135

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Background Patients with repaired tetralogy of Fallot (TOF) are monitored for pulmonary regurgitation (PR), and right ventricular (RV) function. We sought to compare measures of PR and RV function on echocardiogram to those on cardiac magnetic resonance (CMR), and to develop a new tool for assessing PR by echocardiogram. Methods and Results Patients with repaired TOF (N=143, 12.5± 3.2 years) had an echocardiogram and CMR within three months of each other. On echocardiogram, RV function was assessed by (1) Doppler tissue imaging of the RV free wall, and (2) myocardial performance index (MPI). The ratio of diastolic and systolic time-velocity integrals (DSTVI) measured by Doppler of the main pulmonary artery was calculated. CMR variables included RV ejection fraction (EF), RV volumes, and pulmonary regurgitant fraction (RF). Pulmonary regurgitation was graded as mild (RF <20%), moderate (RF=20–40%), and severe (RF>40%). On CMR, RF was 34±17% and RV EF was 61±8%. Echocardiography had good sensitivity identifying cases with RF>20% (sensitivity 97%, 95% CI: 92–99%) but overestimated the amount of PR when RF<20% (false positive rate 36%, 95% CI: 18–57%). The DSTVI on echocardiogram showed moderate correlation with RF on CMR (R=0.60, P<0.0001). On CMR, RF of 20% and 40% corresponded with a DSTVI of 0.49 (95% CI: 0.44–0.56), and 0.72 (95% CI: 0.68–0.76), respectively. RV MPI correlated modestly with RV EF (r=−0.33, P<0.001). Conclusions This study suggests that the DSTVI ratio may make a modest contribution to the overall assessment of PR in patients with repaired TOF and warrants further investigation. However, echocardiography continues to have a limited ability to quantify PR and RV function as compared to CMR.

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Section: Discussionmentioning

confidence: 99%

“…15, 16, 17, 18, 19–23 Likewise, attempts at classifying the severity of PR by echocardiogram have been made. 24, 25 However, the inability of other studies to replicate those measures raises questions as to their validity. 26 …”

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confidence: 99%

Quantifying Pulmonary Regurgitation and Right Ventricular Function in Surgically Repaired Tetralogy of Fallot

Mercer‐Rosa

Yang

Kutty

et al. 2012

Circ: Cardiovascular Imaging

135

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“…Few studies focused on the pediatric age group . Some have explored correlation between Doppler indicators of PR severity and regurgitant fraction calculated by MRI . Others have evaluated echocardiographic parameters of the right ventricle and their agreement with volumes and function estimated by MRI .…”

Section: Resultsmentioning

confidence: 99%

“…In adults with repaired tetralogy of Fallot, flow reversal in the main or branch pulmonary arteries, PR jet width 50% of the pulmonary annular diameter, and PR pressure half‐time <100 ms are independent predictors of severity. PR duration of 80 ms and PHT of 100 ms accurately predicted angiographically severe PR in adults . Other markers of PR severity have been evaluated both in children and in adults .…”

Section: Resultsmentioning

confidence: 99%

Echocardiographic assessment of pediatric semilunar valve disease

et al. 2017

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We reviewed echocardiography literature for the assessment and management of semilunar valve disease in children. A search was performed within the National Library of Medicine using the keywords aortic stenosis (AS), aortic regurgitation, pulmonary stenosis (PS), and pulmonary regurgitation in children. The search was further refined adding the keywords-pediatric, neonates, echocardiographic definition, classification, evaluation. Thirty-eight studies were included. For stenotic lesions, there were sufficient consistencies between Doppler and invasive gradients (especially for PS), while other quantitative parameters used in adults showed significant limitations when applied to children. Heterogeneities remain in the range of Doppler measurements utilized to define mild vs moderate vs severe AS/PS, and to guide management. There is sufficient consensus regarding indications for interventions. In regurgitant lesions, there is weak evidence supporting the use of quantitative or semiquantitative parameters after correction for body surface area; clear indications for intervention are lacking. Because adult echocardiographic recommendations cannot be simply translated to the pediatric age, more specific pediatric guidelines and standards for the assessment of semilunar valve disease are needed.

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“…A pressure half time (< 100 milliseconds) and a no-flow time (> 80 milliseconds) have been shown as the useful parameters for identifying severe pulmonary regurgitation. [2324] This is however also limited by its dependence on RV diastolic properties. In a restrictive RV, a short pressure half-time will reflect an increase in RV end-diastolic pressures.…”

Section: Introductionmentioning

confidence: 99%

Pulmonary regurgitation after tetralogy of fallot repair: A diagnostic and therapeutic challenge

Senthilnathan

Dragulescu

Mertens

2013

J Cardiovasc Echography

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Background:Pulmonary regurgitation is the key hemodynamically significant lesion in repaired tetralogy of Fallot contributing to progressive right ventricular (RV) dilatation and biventricular dysfunction. The timing for pulmonary valve replacement remains a controversial topic, and the decision to intervene depends on assessment of RV size and RV function.Objectives:This review aims to discuss the echocardiographic techniques that can be used to assess patients with pulmonary regurgitation after the repair of tetralogy of Fallot defect. While cardiac magnetic resonance (CMR) imaging is the clinical reference method, there is an important role of echocardiography in identifying patients with significant pulmonary regurgitation and assessing the RV size and function. The different echocardiographic techniques that can be used in this context are discussed. Newer techniques for assessing RV size and function include three-dimensional (3D) echocardiography, tissue Doppler and strain imaging. 3D RV volumetric reconstruction based on two-dimensional imaging is a promising new technique that could potentially replace CMR for RV volumetric assessment.Conclusions:Developments in echocardiographic techniques provide new insights into the impact of pulmonary regurgitation on RV structure and function. Echocardiography and CMR are complementary modalities and further research is required to define the optimal use of both techniques for this indication.

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Quantitative Assessment of Pulmonary Insufficiency by Doppler Echocardiography in Patients with Adult Congenital Heart Disease

Cited by 23 publications

References 27 publications

Quantifying Pulmonary Regurgitation and Right Ventricular Function in Surgically Repaired Tetralogy of Fallot

Quantifying Pulmonary Regurgitation and Right Ventricular Function in Surgically Repaired Tetralogy of Fallot

Echocardiographic assessment of pediatric semilunar valve disease

Pulmonary regurgitation after tetralogy of fallot repair: A diagnostic and therapeutic challenge

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