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[Doppler echocardiographic evaluation of pulmonary hypertension in children]
J Cáceres Espejo1, J Santos de Soto, J L Gavilán Camacho
1Servicio de Cardiología y Hemodinámica Pediátrica, Hospital Infantil Universitario Virgen del Rocío, Sevilla.
Insights
Doppler echocardiography effectively identifies pulmonary hypertension (PH) in children. Pulmonary flow patterns and corrected acceleration time (AcCT) show strong correlations with PH severity, offering a reliable, non-invasive diagnostic tool.
Area of Science:
- Pediatric Cardiology
- Diagnostic Imaging
- Pulmonary Medicine
Background:
- Pulmonary hypertension (PH) poses a significant diagnostic challenge in pediatric cardiology.
- Accurate and non-invasive methods are crucial for assessing PH severity in children.
Purpose of the Study:
- To evaluate the utility of Doppler echocardiography in diagnosing and quantifying the severity of pulmonary hypertension in pediatric patients.
- To correlate echocardiographic findings with hemodynamic measurements in children with and without PH.
Main Methods:
- Doppler echocardiography was performed on 63 children (32 with PH, 31 controls) to analyze pulmonary flow patterns and quantitative parameters.
- Key echocardiographic variables included acceleration time (AcT), pre-ejection period (PEP), ejection period (EP), and their ratios, corrected for heart rate.
- Hemodynamic data, including pulmonary artery pressures, were obtained via cardiac catheterization for comparison.
Main Results:
- Pulmonary flow patterns differentiated between the presence (patterns II and III) and absence (pattern I) of PH (p < 0.001).
- Corrected acceleration time (AcCT) and the PEP/AcT index were significantly altered in children with PH compared to controls (p < 0.001).
- AcT demonstrated strong correlations with systolic pulmonary artery pressure (SPAP) (r = -0.82) and the mean pulmonary pressure/mean systemic pressure ratio (Pp/Sp) (r = -0.84).
Conclusions:
- Doppler echocardiography, by analyzing pulmonary flow patterns and quantitative parameters like AcCT, is a reliable and non-invasive method for evaluating PH in children.
- Echocardiographic assessment of pulmonary flow provides valuable insights into PH presence and severity, complementing hemodynamic data.
Introduction:
We analysed the usefulness of Doppler echocardiography to determine the presence and severity of pulmonary hypertension (PH) in children.
Method:
The whole group consisted of 63 patients, 42 with congenital heart disease that underwent cardiac catheterization (32 of whom had PH = study group) and 21 healthy children. These 21 patients and the remaining 10 without PH at cardiac catheterization made up the control group. All children were studied with Doppler Echocardiography to evaluate the pulmonary flow pattern with the sample volume placed in the pulmonary artery trunk, 1 cm distal to the pulmonic valve. The preejection period (PEP), ejection period (EP), acceleration time (AcT), the indexes PEP/EP, PEP/AcT, AcT/EP and the morphologic pattern of the pulmonary flow (type I: with peak flow velocity at midsystole; type II: with peak flow velocity in early systole; type III: with midsystolic notching) were analysed and quantitative parameters corrected according to hear rate by dividing theirs value by the square root of R-R interval. In the hemodynamic study we analysed the systolic (SPAP), diastolic and mean pulmonary artery pressure, and the mean pulmonary pressure/mean systemic pressure ratio (Pp/Sp). We compared the echocardiographic variables in both, study and control groups, and analysed the hemodynamic and echocardiographic correlation between the variables in question.
Results:
Pattern I of pulmonary flow was associated with absence of PH and pattern II and III with PH (p < 0.001). The best results of quantitative variables were either corrected AcT (AccT) rather less in the study group than in control group (2.89 +/- 0.56 vs 4.05 +/- 0.56 ms, p < 0.001) and PPE/AcT index, 1.28 +/- 0.3 in the hypertensive group and 0.78 +/- 0.16 in the control group (p < 0.001). The best correlation were AcT with SPAP (r = -0.82) and Act with Pp/Sp ratio (r = -0.84).
Conclusions:
We consider that pulmonary flow analysed with Doppler echocardiography is a reliable, suitable and non-invasive method to evaluate PH in children.
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