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Hemodynamic Precision in the Neonatal Intensive Care Unit using Targeted Neonatal Echocardiography
Published on: January 27, 2023
Insight into normal mitral and tricuspid annular dynamics in pediatrics: a real-time three-dimensional
Masaki Nii1, Kevin S Roman, Christopher K Macgowan
1Division of Cardiology, The Hospital for Sick Children, The University of Toronto, Faculty of Medicine, Toronto, Ontario, Canada.
Insights
This study reveals distinct mitral valve (MV) and tricuspid valve (TV) dynamics in children, with the TV’s lateral forces preserving competency. These findings highlight unique pediatric cardiac mechanics and valve interactions.
Area of Science:
- Pediatric Cardiology
- Cardiac Mechanics
- Echocardiography
Background:
- Limited data exist on the interaction between the mitral valve (MV) and tricuspid valve (TV).
- Previous studies focused on adult or animal models, analyzing MV or TV annular motion separately.
- No studies have investigated these dynamics in the pediatric population.
Purpose of the Study:
- To analyze the interaction and annular motion of the mitral valve (MV) and tricuspid valve (TV) in healthy children.
- To compare pediatric MV and TV dynamics with existing adult data.
- To investigate the relationship between valve motion and ventricular forces in children.
Main Methods:
- Utilized real-time 3-dimensional echocardiography for data acquisition.
- Analyzed annular area, perimeter, segmental diameter, and bending angle in 17 healthy children (age 3-15).
- Focused on dynamic changes during the cardiac cycle.
Main Results:
- Mitral valve (MV) area increased during systole, while tricuspid valve (TV) area decreased.
- The TV showed a greater reduction in lateral diameter during systole.
- Tricuspid valve (TV) bending motion was more acute in early diastole compared to the MV.
Conclusions:
- Pediatric MV area changes differ from adults, potentially due to a more compliant myocardium.
- Greater lateral forces on the TV help maintain valve competency by preventing circularity.
- Both MV and TV exhibit bending motion, particularly during isovolumic relaxation and early diastole for the TV, suggesting a link to ventricular torsional forces.
Background:
Although there are animal or adult studies analyzing annular motion of the mitral valve (MV) or tricuspid valve (TV) separately, there are no data analyzing interaction between the MV and TV, or data from the pediatric population.
Methods:
A total of 17 healthy children (age 3-15 years) were enrolled in this study. Using real-time 3-dimensional echocardiography, annular area, perimeter, segmental diameter, and bending angle were obtained and analyzed.
Results:
MV area increased during systole, in contrast to TV area, which decreased. TV area demonstrated a greater reduction of lateral diameter during systole. Bending motion became most acute in early diastole, which was greater for the TV.
Conclusions:
MV area change differs from adults, which may be explained by a more compliant myocardium in children. Greater lateral forces on TV prevent it from becoming circular, thus, preserving valve competency. Both valves show a bending motion, which becomes most prominent during isovolumic relaxation continuing into early diastole for the TV, suggesting a relationship with torsional forces within the ventricles.
