The Comparison between the Echocardiographic Data to the Cardiac Catheterization Data on the Diagnosis, Treatment, and Follow-Up in Patients Diagnosed as Pulmonary Valve Stenosis

Abstract

BackgroundIsolated pulmonary valve stenosis (PS) makes up 6-9% of all congenital heart defects among children. The initial gold standard for diagnosis, follow-up of PS is by echocardiography. However, the most accurate diagnosis still remains to be measurement of the pressure gradient through transcatheterization. The purpose of this study is to compare the difference between the echocardiographic data to the cardiac catheterization data on the diagnosis, treatment, and follow-up in patients diagnosed as PS, and to see what parameters should be closely monitored.MethodsA total of 112 patients (Male : Female = 46 : 66) who underwent balloon pulmonary valvuloplasty (BPV) at Severance Cardiovascular Hospital, between December, 2002 to August, 2012 were retrospectively analyzed. The patients were all under 16 years of age and critical PS patients who underwent BPV were excluded from this study.ResultsThe pre-BPV right ventricle (RV)-pulmonary artery (PA) systolic pressure gradient and post-BPV systolic pressure gradient showed statistically significant decrease. The pre-BPV RV-PA systolic pressure gradient and 3 month post-BPV systolic pressure gradient showed statistically significant decrease. The consistency between the echocardiographic data and cardiac catheterization data shows statistically significant consistency. The mean pressure gradient and systolic pressure gradient on the echocardiography shows high consistency when comparing with the cardiac catheterization data.ConclusionOur study shows that BPV in PS is a safe and effective procedure in children and adolescent. The standard echocardiographic evaluation of PS, during diagnosis and follow-up, should include mean transpulmonic pressure gradient, as well as the peak systolic pressure gradient. The success of the procedure should be held off until at least 3 months, only if the patients do not show any symptoms.

Echocardiographic assessment of pediatric semilunar valve disease

“…Most studies investigated echocardiographic determinants of clinical course in small‐to‐moderate PS, while others proposed recommendations for follow‐up and management . Evidence of accuracy of echo Doppler gradients is derived largely from interventional series with only one study specifically designed for comparison of echocardiographic Doppler gradients with invasive gradients . There are multiple studies on critical neonatal pulmonary stenosis, which are beyond the scope of this paper.…”

“…The lack of standardization in the echocardiographic assessment of aortic and pulmonary valve disease in children may produce heterogeneities in the assessment of disease severity. For example, varied thresholds for transvalvular gradient have been used to define mild, moderate, or severe obstruction in aortic and pulmonary stenosis . The aim of this article was to review the literature on pediatric semilunar valvular heart disease, focusing specifically on the heterogeneity and limitations of current echocardiographic classification systems.…”

“…For example, varied thresholds for transvalvular gradient have been used to define mild, moderate, or severe obstruction in aortic and pulmonary stenosis. 1,[37][38][39][40][41][42][43][44] The aim of this article was to review the literature on pediatric semilunar valvular heart disease, focusing specifically on the heterogeneity and limitations of current echocardiographic classification systems. The authors will also summarize the current evidence for the management and follow-up of these defects.…”

Correlation of echocardiographic and angiographic measurements of the pulmonary valve annulus in pulmonary stenosis

“…Previous publications showed a good correlation between echocardiographically derived pressure gradient estimations and subsequent cardiac catheter measurements , but there are extremely limited data for the correlation of PV measurements. Dev et al reviewed PV annulus measurements in 26 patients and found a close correlation, but correlation of measurements is to be expected and is not sufficient to recommend or abandon angiographic measurements.…”

Simplified Bernoulli's method significantly underestimates pulmonary transvalvular pressure drop

“…Pulmonary valve stenosis is a common anomaly in patients with congenital heart defects. Quantitative assessment of the severity of pulmonary valve stenosis is mainly based on the pulmonary transvalvular pressure drop, commonly estimated by continuous‐wave Doppler and recently by magnetic resonance imaging (MRI) phase contrast flow measurements . The accuracy of noninvasive measurements of the transvalvular pressure drop has been debated .…”