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Right-sided valvular regurgitation in normal children determined by combined colour-coded and continuous-wave Doppler
A P Van Dijk1, A M Van Oort, O Daniëls
1Academic Children's Heart Centre, University Hospital Nijmegen, The Netherlands.
Insights
Right-sided valvular regurgitation, including pulmonary and tricuspid regurgitation, is common and typically physiological in healthy children. These echocardiographic findings are usually hemodynamically insignificant and should not be misdiagnosed as heart disease.
Area of Science:
- Pediatric Cardiology
- Diagnostic Imaging
Background:
- Right-sided valvular regurgitation is often detected using Doppler echocardiography.
- Understanding its prevalence in healthy children is crucial for accurate diagnosis.
Purpose of the Study:
- To prospectively determine the prevalence of tricuspid and pulmonary valve regurgitation in normal children.
- To assess the influence of factors like age, gender, and innocent heart murmurs on regurgitation prevalence.
Main Methods:
- Doppler echocardiography was used to evaluate 173 healthy children (aged 5-14 years).
- Specific criteria were applied to define and quantify pulmonary and tricuspid regurgitation.
- Statistical analysis explored correlations with demographic and clinical factors.
Main Results:
- Pulmonary regurgitation was detected in 84% of children, and tricuspid regurgitation in 8%.
- A very short-duration tricuspid regurgitation, likely from valve closure, was found in 75%.
- No significant association was found between regurgitation prevalence and age, gender, or innocent heart murmurs.
Conclusions:
- Right-sided valvular regurgitation is a common physiological finding in healthy schoolchildren.
- These echocardiographic signals are generally hemodynamically insignificant.
- Avoiding iatrogenic heart disease requires recognizing these findings as normal variations.
Abstract:
Using Doppler echocardiography, the prevalence of tricuspid and pulmonary valve regurgitation was determined prospectively in 173 normal children, aged 8.3 +/- 2.7 (range 5-14) years. Pulmonary regurgitation was defined as a red-yellow or mosaic coloured regurgitant flow, continuing to end-diastole with continuous-wave Doppler. It was found in 84% of the children. Tricuspid regurgitation was defined as a blue-green or mosaic coloured regurgitant flow from the tricuspid valve into the right atrium lasting > 0.5 systole, as determined by continuous-wave Doppler. Tricuspid regurgitation was present in only 8% of the children. Tricuspid regurgitation flow of very short duration, considered to be due to valve closure, was found in 75%. No effect of age, presence of a vibratory innocent heart murmur or gender on the prevalence of right-sided valvular regurgitation could be demonstrated. All regurgitations were haemodynamically insignificant. Thus right-sided valvular regurgitation in normal schoolchildren is a normal physiological finding with relatively high prevalence. In the absence of functional reasons for these regurgitations and in the absence of structural pulmonary or tricuspid valve disease, these signals should be considered physiological in order to avoid iatrogenic heart disease.