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The right ventricular outflow tract in pediatric pulmonary hypertension—Data from the European Pediatric Pulmonary Vascular Disease Network
Author(s) -
Koestenberger Martin,
Avian Alexander,
Sallmon Hannes,
Gamillscheg Andreas,
Grangl Gernot,
KurathKoller Stefan,
Schweintzger Sabrina,
Burmas Ante,
Hansmann Georg
Publication year - 2018
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/echo.13852
Subject(s) - ventricular outflow tract , medicine , cardiology , pulmonary hypertension , cohort , afterload , regurgitation (circulation) , heart disease , diastole , hemodynamics , blood pressure
Objective The right ventricular outflow tract ( RVOT ) is pivotal for adequate RV function and known to be adversely affected by elevated pulmonary arterial pressure ( PAP ) in adults with pulmonary hypertension ( PH ). Aim of this study was to determine the effects of increased RV pressure afterload in children with PH on RVOT size, function, and flow parameters. Methods We conducted a transthoracic echocardiographic study in 51 children with PH (median age: 5.3 years; range 1.5 months to 18 years) and determined the following RVOT variables: RVOT diameter, RVOT velocity time integral ( VTI ), ratio of tricuspid regurgitation velocity ( TRV )/ RVOT VTI , and RVOT systolic excursion ( SE ). Results In our pediatric PH cohort, the age‐specific RVOT diameter z ‐score was higher compared to normal values. Deviation from normal RVOT diameter values increased with age, disease severity, and New York Heart Association functional class. Significant correlations were found between RVOT diameter and the RV end‐diastolic area and right atrial area. The age‐specific RVOT VTI z ‐score values were significantly lower in children with PH vs healthy controls. The TRV / RVOT VTI ratio increased with rising systolic RV pressure, while the RVOT SE was similar between PH children and control subjects. Conclusions In pediatric PH cohort, the RVOT VTI is decreased, and the TRV / RVOT VTI ratio and the RVOT diameter increased compared to healthy subjects. Assessment of RVOT variables, together with established RV parameters, allows for a comprehensive assessment of global right heart size and performance in children with PH .