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Right heart pressure determination by Doppler in infants with tricuspid regurgitation
J R Skinner1, A G Stuart, J O'Sullivan
1Department of Paediatric Cardiology, Freeman Hospital, Newcastle upon Tyne.
Insights
Doppler echocardiography accurately estimates right ventricle to right atrial pressure drop in infants with congenital heart disease. This reproducible method aids in assessing right ventricular pressure in pediatric patients.
Area of Science:
- Pediatric Cardiology
- Echocardiography
- Congenital Heart Disease
Background:
- Accurate estimation of right ventricular pressure is crucial for managing infants with congenital heart disease.
- Previous validation of Doppler-derived pressure drop measurements was limited to older children and adults.
Purpose of the Study:
- To validate the accuracy and reproducibility of Doppler-derived right ventricle to right atrial pressure drop measurements in infants.
- To assess the clinical significance of any discrepancies between Doppler and direct pressure measurements.
Main Methods:
- Cardiac catheterization was performed in 26 infants with congenital heart disease.
- Right ventricle to right atrial pressure drop was measured directly and calculated using continuous wave Doppler and the modified Bernoulli equation.
- Inter-observer variability was assessed in 16 newborn infants.
Main Results:
- A high correlation (r=0.95) was observed between direct and Doppler measurements.
- Doppler measurements showed a slight, clinically insignificant underestimation (mean 2 mm Hg) of the pressure drop.
- The method demonstrated good reproducibility with a coefficient of repeatability of 6.3 mm Hg.
Conclusions:
- Doppler echocardiography is a reproducible and accurate technique for estimating right ventricular pressure in infants with tricuspid regurgitation.
- This non-invasive method provides valuable hemodynamic information in pediatric cardiology.
- The findings support the use of Doppler for right ventricular pressure assessment in infants with congenital heart disease.
Abstract:
Doppler and direct measurements of right ventricle to right atrial pressure drop were made during cardiac catheterisation on 28 occasions in 26 infants with congenital heart disease. Age was 10 days to 12 months (median 4.5 months), and weight was 3.1 to 9.0 kg (median 4.7 kg). We measured peak velocity of tricuspid regurgitation by continuous wave Doppler, and the pressure drop was calculated using the modified Bernoulli equation (delta p = 4v2). There was a high correlation (r = 0.95) between direct and Doppler measurements. Doppler values tended to underestimate the right ventricle to right atrial pressure drop, but this was not of clinical significance (mean 2 mm Hg). The 95% confidence interval for the Doppler velocity was -0.41 to +0.26 m/sec, and was consistent across the range of pressures studied. Variability between observers was tested, by two observers performing sequential paired examinations on 16 newborn babies with tricuspid regurgitation. The coefficient of repeatability was 6.3 mm Hg (95% confidence interval 4.7 to 9.5 mm Hg) or 0.26 m/sec (0.18 to 0.50 m/sec). This method of right ventricular pressure estimation, validated previously only in older children and adults, is a reproducible and accurate technique in infants with tricuspid regurgitation.