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Published on: June 29, 2013
Natural course of isolated pulmonary valve stenosis in infants and children utilizing Doppler echocardiography
D G Rowland1, W W Hammill, H D Allen
1Department of Pediatrics, The Ohio State University, Children's Hospital, Columbus 43205, USA.
Insights
Pulmonary stenosis (PS) in infants may worsen, especially in the first month of life. Mild PS in newborns requires close monitoring as it can progress more rapidly than in older children.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Research
- Medical Imaging
Background:
- Limited natural history data for pulmonary stenosis (PS) exists, primarily from older cardiac catheterization studies.
- Previous studies often excluded infants and patients with mild disease, creating selection bias.
- Doppler echocardiography now enables precise, serial assessment of PS in all pediatric age groups.
Purpose of the Study:
- To evaluate the natural history of pulmonary stenosis (PS) in pediatric patients.
- To utilize serial Doppler echocardiography for assessing PS progression.
- To identify risk factors and patterns of progression in different age groups.
Main Methods:
- Retrospective analysis of 147 pediatric patients with PS and serial echocardiographic data.
- Patients' ages ranged from 2 days to 15 years at initial evaluation.
- Mean follow-up duration was 2.4 years.
Main Results:
- 29% of infants evaluated within 1 month showed a peak systolic pressure gradient increase of ≥20 mm Hg, versus 8% evaluated later.
- 28% of newborns with mild PS progressed to moderate or severe PS, compared to 15% of older infants.
- Newborns with moderate PS and those experiencing rapid gradient increases (<6 months) showed higher progression rates.
Conclusions:
- Mild pulmonary stenosis (PS) is not always static, particularly in young infants.
- Progression of PS is more common and rapid in newborns compared to older children.
- Early and serial Doppler assessments are crucial for managing pediatric PS, especially in infants.
Abstract:
Most natural history data regarding pulmonary stenosis (PS) were obtained from cardiac catheterization studies over 15 to 20 years ago. Selection bias in these studies often excluded patients with mild disease and infants. Today, Doppler echocardiography allows accurate serial assessments of stenotic lesions in patients of all ages. This study evaluates the natural history of PS utilizing serial Doppler examinations in the pediatric population. A total of 147 patients with PS and serial echocardiographic data were identified. Age at initial echocardiogram ranged from 2 days to 15 years, with a mean follow-up of 2.4 years. Sixteen of 56 patients (29%) initially evaluated within 1 month had a > or = 20 mm Hg increase in their peak systolic pressure gradient. Only 7 of 89 patients (8%) initially evaluated over 1 month had a > or = 20 mm Hg increase. Eleven of 40 newborn infants (28%) with mild obstruction had progression to moderate or severe PS compared with 10 of 68 patients (15%) initially evaluated over 1 month. Moderate PS in the newborn was also more likely to progress compared with older children. Of the 16 newborns with > or = 20 mm Hg increases, 8 developed the increase in < or = 6 months. In contrast, no patient aged >2 years whose initial gradient was <50 mm Hg developed severe PS. Mild PS may not be static, particularly in young infants. Progression in this age group occurs more often and more rapidly than in older infants and children.
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