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Echocardiography in pediatric pulmonary hypertension.

Jone PN, Ivy DD - Front Pediatr (2014)

Bottom Line: Pulmonary hypertension (PH) can be a rapidly progressive and fatal disease.Although right heart catheterization remains the gold standard in evaluation of PH, echocardiography remains an important tool in screening, diagnosing, evaluating, and following these patients.In this article, we will review the important echocardiographic parameters of the right heart in evaluating its anatomy, hemodynamic assessment, systolic, and diastolic function in children with PH.

View Article: PubMed Central - PubMed

Affiliation: Pediatric Cardiology, Children's Hospital Colorado, University of Colorado School of Medicine , Aurora, CO , USA.

ABSTRACT
Pulmonary hypertension (PH) can be a rapidly progressive and fatal disease. Although right heart catheterization remains the gold standard in evaluation of PH, echocardiography remains an important tool in screening, diagnosing, evaluating, and following these patients. In this article, we will review the important echocardiographic parameters of the right heart in evaluating its anatomy, hemodynamic assessment, systolic, and diastolic function in children with PH.

No MeSH data available.


Related in: MedlinePlus

Parasternal short axis view of the right and left ventricles at the level of the papillary muscles. The RV/LV ratio is derived from RV diameter and LV diameter at end-systole.
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Figure 4: Parasternal short axis view of the right and left ventricles at the level of the papillary muscles. The RV/LV ratio is derived from RV diameter and LV diameter at end-systole.

Mentions: Right ventricular pressure overload causes flattening of the interventricular septum (IVS) in end-systole into the left ventricle (LV), resulting a “D-shaped” LV in parasternal short axis view. Eccentricity index has been derived from the ratio between the LV anteroposterior dimension and the septolateral dimension at the level of the papillary muscle (Figure 3) (15). LV deformation of the IVS is greatest in end-systole in patients with RV pressure overload. Eccentricity index is abnormal when the ratio is >1.0 and has been shown to correlate well with invasive measurements of pulmonary artery pressure and associated with adverse clinical outcome in adults with PH (5, 16). Serial evaluation of eccentricity index with improvement in this index has been shown in targeted PH therapy in adults (17). The eccentricity index has been shown in children to be worse in patients with idiopathic PH compared to PH associated with congenital heart disease (6). Flattening of the IVS can be classified into mild, moderate, or severe depending on the degree of PH (Figure 3). In the absence of tricuspid regurgitation (TR) to estimate RV pressure, septal flattening offers indirect evidence of elevated pulmonary artery pressure. End-systolic flattening of the IVS has proven to be a sensitive marker for RV systolic hypertension in children (18). RV/LV ratio at end-systole measured at the level of the papillary muscles incorporates RV dimension in the parasternal short axis view and has been shown to correlate with invasive measures of hemodynamics and RV/LV end-systolic ratio >1 is associated with adverse clinical outcomes in children with PH (Figure 4) (19). Flattening of IVS into the LV impairs LV filling. Both the systolic and diastolic volumes are reduced. The importance of ventricular–ventricular interactions is increasingly recognized in patients with PH in both adult and pediatric populations (20, 21). Interventricular septal shift impairs LV diastolic filling, which results in decreased LV function. In severe PH with severe septal shift, the LV mid-cavity or outflow tract may become obstructed and the cardiac output (CO) can be decreased. CO can be estimated from echocardiography by the following equation:CO=LVOT diameter∕22×3.14×VTI LVOT×HR


Echocardiography in pediatric pulmonary hypertension.

Jone PN, Ivy DD - Front Pediatr (2014)

Parasternal short axis view of the right and left ventricles at the level of the papillary muscles. The RV/LV ratio is derived from RV diameter and LV diameter at end-systole.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4228850&req=5

Figure 4: Parasternal short axis view of the right and left ventricles at the level of the papillary muscles. The RV/LV ratio is derived from RV diameter and LV diameter at end-systole.
Mentions: Right ventricular pressure overload causes flattening of the interventricular septum (IVS) in end-systole into the left ventricle (LV), resulting a “D-shaped” LV in parasternal short axis view. Eccentricity index has been derived from the ratio between the LV anteroposterior dimension and the septolateral dimension at the level of the papillary muscle (Figure 3) (15). LV deformation of the IVS is greatest in end-systole in patients with RV pressure overload. Eccentricity index is abnormal when the ratio is >1.0 and has been shown to correlate well with invasive measurements of pulmonary artery pressure and associated with adverse clinical outcome in adults with PH (5, 16). Serial evaluation of eccentricity index with improvement in this index has been shown in targeted PH therapy in adults (17). The eccentricity index has been shown in children to be worse in patients with idiopathic PH compared to PH associated with congenital heart disease (6). Flattening of the IVS can be classified into mild, moderate, or severe depending on the degree of PH (Figure 3). In the absence of tricuspid regurgitation (TR) to estimate RV pressure, septal flattening offers indirect evidence of elevated pulmonary artery pressure. End-systolic flattening of the IVS has proven to be a sensitive marker for RV systolic hypertension in children (18). RV/LV ratio at end-systole measured at the level of the papillary muscles incorporates RV dimension in the parasternal short axis view and has been shown to correlate with invasive measures of hemodynamics and RV/LV end-systolic ratio >1 is associated with adverse clinical outcomes in children with PH (Figure 4) (19). Flattening of IVS into the LV impairs LV filling. Both the systolic and diastolic volumes are reduced. The importance of ventricular–ventricular interactions is increasingly recognized in patients with PH in both adult and pediatric populations (20, 21). Interventricular septal shift impairs LV diastolic filling, which results in decreased LV function. In severe PH with severe septal shift, the LV mid-cavity or outflow tract may become obstructed and the cardiac output (CO) can be decreased. CO can be estimated from echocardiography by the following equation:CO=LVOT diameter∕22×3.14×VTI LVOT×HR

Bottom Line: Pulmonary hypertension (PH) can be a rapidly progressive and fatal disease.Although right heart catheterization remains the gold standard in evaluation of PH, echocardiography remains an important tool in screening, diagnosing, evaluating, and following these patients.In this article, we will review the important echocardiographic parameters of the right heart in evaluating its anatomy, hemodynamic assessment, systolic, and diastolic function in children with PH.

View Article: PubMed Central - PubMed

Affiliation: Pediatric Cardiology, Children's Hospital Colorado, University of Colorado School of Medicine , Aurora, CO , USA.

ABSTRACT
Pulmonary hypertension (PH) can be a rapidly progressive and fatal disease. Although right heart catheterization remains the gold standard in evaluation of PH, echocardiography remains an important tool in screening, diagnosing, evaluating, and following these patients. In this article, we will review the important echocardiographic parameters of the right heart in evaluating its anatomy, hemodynamic assessment, systolic, and diastolic function in children with PH.

No MeSH data available.


Related in: MedlinePlus