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Echocardiographic assessment of pulmonary arterial pressure in children with complete right bundle branch block
Insights
Echocardiography can accurately assess right ventricular afterload in children with congenital heart disease. The isovolumic contraction time effectively estimates pulmonary arterial pressures, even with conduction abnormalities.
Area of Science:
- Pediatric Cardiology
- Echocardiography
- Congenital Heart Disease
Background:
- The isovolumic contraction time (IVCT) of the right ventricle is the interval between tricuspid and pulmonary valve opening.
- Assessing right ventricular afterload is crucial in managing congenital heart disease (CHD).
Purpose of the Study:
- To evaluate the utility of echocardiographically determined IVCT for assessing right ventricular afterload in children.
- To determine if IVCT can differentiate normal from elevated pulmonary arterial pressures in pediatric CHD patients.
Main Methods:
- Echocardiography was used to measure IVCT in 38 healthy children and 53 children with CHD.
- IVCT was correlated with pulmonary arterial end-diastolic pressure (PAEDP), mean pulmonary arterial pressure, and pulmonary vascular resistance.
- IVCT was also assessed in 15 children with complete right bundle branch block (RBBB).
Main Results:
- In children with CHD, IVCT strongly correlated with PAEDP (r=0.87).
- IVCT successfully distinguished between normal and elevated PAEDP.
- Children with RBBB showed no significant difference in IVCT compared to those without conduction abnormalities at similar PAEDP levels.
Conclusions:
- Echocardiographic IVCT provides an accurate and reproducible method for assessing right ventricular afterload in children with CHD.
- This non-invasive technique is valuable for serial monitoring, even in the presence of RBBB.
Abstract:
The time interval between tricuspid valve closure and pulmonary valve opening, termed the isovolumic contraction time of the right ventricle, was evaluated echographically in 38 normal children and within 24 hours of cardiac catheterization in 53 children with congenital heart disease and normal conduction as assessed with the electrocardiogram. In the 53 patients with congenital heart disease, isovolumic contraction time was strongly influenced by right ventricular afterload, as defined by pulmonary arterial end-diastolic pressure (r = 0.87). It was possible to utilize isovolumic contraction time to separate patients with normal or elevated values for pulmonary arterial end-diastolic pressure. Similar correlations were demonstrated between isovolumic contraction time and mean pulmonary arterial pressure and calculated pulmonary vascular resistance. Evaluation of 15 children with complete right bundle branch block revealed values for isovolumic contraction time that did not significantly differ from those of patients with similar pulmonary arterial end-diastolic pressure but no conduction abnormalities. These findings indicate that serial echographic evaluation of the interval from tricuspid valve closure to pulmonary valve opening can give an accurate reproducible assessment of right ventricular afterload in many children with congenital heart disease and complete right bundle branch block