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Cantinotti M, Di Salvo G, Voges I, Raimondi F, Greil G, Ortiz Garrido A, Bharucha T, Grotenhuis HB, Köstenberger M, Bonnello B, Miller O, McMahon CJ. Standardization in paediatric echocardiographic reporting and critical interpretation of measurements, functional parameters, and prediction scores: a clinical consensus statement of the European Association of Cardiovascular Imaging of the European Society of Cardiology and the Association for European Paediatric and Congenital Cardiology. Eur Heart J Cardiovasc Imaging 2024; 25:1029-1050. [PMID: 38833586 DOI: 10.1093/ehjci/jeae147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 05/23/2024] [Indexed: 06/06/2024] Open
Abstract
This document has been developed to provide a guide for basic and advanced reporting in paediatric echocardiography. Furthermore, it aims to help clinicians in the interpretation of echocardiographic measurements and functional data for estimating the severity of disease in different paediatric age groups. The following topics will be reviewed and discussed in the present document: (i) the general principle in constructing a paediatric echocardiographic report, (ii) the basic elements to be included, and (iii) the potential and limitation of currently employed tools used for disease severity quantification during paediatric reporting. A guide for the interpretation of Z-scores will be provided. Use and interpretation of parameters employed for quantification of ventricular systolic function will be discussed. Difficulties in the adoption of adult parameters for the study of diastolic function and valve defects at different ages and pressure and loading conditions will be outlined, with pitfalls for the assessment listed. A guide for careful use of prediction scores for complex congenital heart disease will be provided. Examples of basic and advanced (disease-specific) formats for reporting in paediatric echocardiography will be provided. This document should serve as a comprehensive guide to (i) structure a comprehensive paediatric echocardiographic report; (ii) identify the basic morphological details, measures, and functional parameters to be included during echocardiographic reporting; and (iii) correctly interpret measurements and functional data for estimating disease severity.
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Affiliation(s)
- Massimiliano Cantinotti
- Department of Pediatric Cardiology and Congenital Heart Disease, National Research Council-Tuscany Region G. Monasterio Foundation (FTGM), Massa, Pisa 54100, Italy
| | - Giovanni Di Salvo
- Paediatric Cardiology and Congenital Heart Disease, Woman and Children's Health Department, University of Padua; Experimental Cardiology, Paediatric Research Institute (IRP), Padua, Italy
| | - Inga Voges
- Department of Congenital Heart Disease and Pediatric Cardiology, DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, University Hospital Schleswig-Holstein, Kiel, Germany
| | | | - Gerald Greil
- Division Pediatric Cardiology, UT Southwestern, Dallas, TX, USA
| | | | - Tara Bharucha
- Department of Paediatric Cardiology, University Hospital Southampton, Southampton, UK
| | - Heynric B Grotenhuis
- Department Pediatric Cardiology, Wilhelmina Children's Hospital/UMCU, Utrecht, The Netherlands
| | - Martin Köstenberger
- Department of Pediatrics, Division of Pediatric Cardiology, Medical University of Gratz, Gratz, Austria
| | | | - Owen Miller
- Department Pediatric Cardiology, Evelina London Children's Hospital, London, UK
| | - Colin J McMahon
- Department Paediatric Cardiology, Children's Health Ireland at Crumlin, Dublin, Ireland
- School of Medicine, University College Dublin, Belfield, Dublin, Ireland
- Maastricht School of Health Professions Education, Maastricht, The Netherlands
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Lopez L, Saurers DL, Barker PCA, Cohen MS, Colan SD, Dwyer J, Forsha D, Friedberg MK, Lai WW, Printz BF, Sachdeva R, Soni-Patel NR, Truong DT, Young LT, Altman CA. Guidelines for Performing a Comprehensive Pediatric Transthoracic Echocardiogram: Recommendations From the American Society of Echocardiography. J Am Soc Echocardiogr 2024; 37:119-170. [PMID: 38309834 DOI: 10.1016/j.echo.2023.11.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2024]
Abstract
Echocardiography is a fundamental component of pediatric cardiology, and appropriate indications have been established for its use in the setting of suspected, congenital, or acquired heart disease in children. Since the publication of guidelines for pediatric transthoracic echocardiography in 2006 and 2010, advances in knowledge and technology have expanded the scope of practice beyond the use of traditional modalities such as two-dimensional, M-mode, and Doppler echocardiography to evaluate the cardiac segmental structures and their function. Adjunct modalities such as contrast, three-dimensional, and speckle-tracking echocardiography are now used routinely at many pediatric centers. Guidelines and recommendations for the use of traditional and newer adjunct modalities in children are described in detail in this document. In addition, suggested protocols related to standard operations, infection control, sedation, and quality assurance and improvement are included to provide an organizational structure for centers performing pediatric transthoracic echocardiograms.
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Affiliation(s)
- Leo Lopez
- Department of Pediatrics Cardiology, Stanford University School of Medicine and Lucile Packard Children's Hospital Stanford, Palo Alto, California.
| | - Daniel L Saurers
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Piers C A Barker
- Duke Children's Hospital & Health Center, Duke University, Durham, North Carolina
| | - Meryl S Cohen
- Cardiac Center and Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Steven D Colan
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
| | - Jeanine Dwyer
- Pediatric Heart Institute, Children's Hospital Colorado, Aurora, Colorado
| | - Daniel Forsha
- Ward Family Heart Center, Children's Mercy Kansas City Hospital, Kansas City, Missouri
| | - Mark K Friedberg
- Labatt Family Heart Centre, Division of Cardiology, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Wyman W Lai
- Division of Pediatric Cardiology, University of California School of Medicine, Irvine, California; Department of Pediatrics, Children's Hospital of Orange County, Orange, California
| | - Beth F Printz
- Rady Children's Hospital San Diego and University of California, San Diego, San Diego, California
| | - Ritu Sachdeva
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Neha R Soni-Patel
- Pediatric & Adult Congenital Heart Center, Cleveland Clinic Children's Hospital, Cleveland, Ohio
| | - Dongngan T Truong
- University of Utah and Division of Pediatric Cardiology, Primary Children's Hospital, Salt Lake City, Utah
| | - Luciana T Young
- Seattle Children's Hospital and Pediatric Cardiology, University of Washington School of Medicine, Seattle, Washington
| | - Carolyn A Altman
- Baylor College of Medicine and Texas Children's Heart Center, Texas Children's Hospital, Houston, Texas
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Vogl B, Gadhave R, Wang Z, El Shaer A, Chavez Ponce A, Alkhouli M, Hatoum H. Effect of aortic curvature on bioprosthetic aortic valve performance. J Biomech 2023; 146:111422. [PMID: 36610388 DOI: 10.1016/j.jbiomech.2022.111422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 12/13/2022] [Accepted: 12/23/2022] [Indexed: 12/25/2022]
Abstract
Transvalvular pressure gradient (ΔP) after aortic valve replacement is an important surrogate of aortic bioprostheses performance. Invasive ΔP is often measured after transcatheter aortic valve replacement to exclude patient-prosthetic mismatch. However, invasive aortic pressures are usually recorded in the pressure recovery (PR) zone downstream of the valve, potentially resulting in ΔP underestimation compared to noninvasive measurements. PR was extensively studied in straight ascending aortas. However, the impact of various aortic arch configurations on ΔP has not been explored. PR was assessed in a pulse duplicating simulator at various cardiac conditions of cardiac output, heart rates and pressures. Three different aortic geometries with identical root dimensions but with different aortic arches were used: (1) curvature 1, (2) curvature 2, and (3) straight aortic models. Instantaneous pressure and peak ΔP measurements were recorded incrementally along the models for each cardiac condition. The models with aortic arches produced two distinct PR zones (after the valve and after the aortic arch), whereas the model without an aortic arch produced only one PR zone (after the valve). The trend of the pressure and ΔP curves for each model was independent of the cardiac condition used, but the individually measured pressure magnitudes did change with different conditions. In this study, we illustrated the differences in PR between distinct aortic curvatures and straight aorta. PR affects pressure and ΔP measurements. These effects are clear when recording aortic pressures by catheterization and echocardiography.
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Affiliation(s)
- Brennan Vogl
- Department of Biomedical Engineering, Michigan Technological University, Houghton, MI, USA
| | - Rajat Gadhave
- Department of Biomedical Engineering, Michigan Technological University, Houghton, MI, USA
| | - Zhenyu Wang
- Department of Mechanical Engineering, The Ohio State University, Columbus, OH, USA; Simulation Innovation and Modeling Center, The Ohio State University, Columbus, OH, USA
| | - Ahmed El Shaer
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Mohamad Alkhouli
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Hoda Hatoum
- Department of Biomedical Engineering, Michigan Technological University, Houghton, MI, USA; Health Research Institute, Center of Biocomputing and Digital Health and Institute of Computing and Cybernetics, Michigan Technological University, Houghton, MI, USA.
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Effect of Pressure Recovery on Pressure Gradients in Congenital Stenotic Outflow Lesions in Pediatric Patients—Clinical Implications of Lesion Severity and Geometry: A Simultaneous Doppler Echocardiography and Cardiac Catheter Correlative Study. J Am Soc Echocardiogr 2020; 33:207-217. [DOI: 10.1016/j.echo.2019.09.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 09/02/2019] [Accepted: 09/06/2019] [Indexed: 11/18/2022]
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Singh GK. Congenital Aortic Valve Stenosis. CHILDREN-BASEL 2019; 6:children6050069. [PMID: 31086112 PMCID: PMC6560383 DOI: 10.3390/children6050069] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 05/01/2019] [Accepted: 05/08/2019] [Indexed: 12/18/2022]
Abstract
Aortic valve stenosis in children is a congenital heart defect that causes fixed form of hemodynamically significant left ventricular outflow tract obstruction with progressive course. Neonates and young infants who have aortic valve stenosis, usually develop congestive heart failure. Children and adolescents who have aortic valve stenosis, are mostly asymptomatic, although they may carry a small but significant risk of sudden death. Transcatheter or surgical intervention is indicated for symptomatic patients or those with moderate to severe left ventricular outflow tract obstruction. Many may need reintervention.
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Affiliation(s)
- Gautam K Singh
- Washington University School of Medicine, Department of Pediatrics, Campus Box 8116-NWT, 1 Children's Place, Saint Louis, MO 63110, USA.
- St. Louis Children's Hospital, 1 Children's Place, St. Louis, MO 63110, USA.
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Prognostic Value of Energy Loss Coefficient for Predicting Asymptomatic Aortic Stenosis Outcomes: Direct Comparison With Aortic Valve Area. J Am Soc Echocardiogr 2019; 32:351-358.e3. [DOI: 10.1016/j.echo.2018.10.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Indexed: 11/22/2022]
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Abbas AE, Pibarot P. Hemodynamic characterization of aortic stenosis states. Catheter Cardiovasc Interv 2019; 93:1002-1023. [PMID: 30790429 DOI: 10.1002/ccd.28146] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 01/29/2019] [Indexed: 11/12/2022]
Abstract
Aortic stenosis (AS) has become an increasingly prevalent clinical condition, as a result of the "greying of the population", the widespread application of sophisticated diagnostic tools including non-invasive imaging and invasive techniques, and the advent of minimally invasive surgical and percutaneous valve therapies. The diagnosis of severe AS traditionally has relied on the assessment of the mean transvalvular gradient (ΔPmean ) and aortic valve area (AVA) by either echocardiography or catheterization. However, other hemodynamic variables as flow, pressure recovery, and jet eccentricity also play a major role in determining the final hemodynamic state of AS. Moreover, mismatch between ΔPmean and AVA as in low flow low gradient AS and discordance between catheterization and echocardiographic studies in grading severity of AS have increased the complexity of AS diagnosis. The present case-based treatise emphasizes a multi-modality approach to delineation of the hemodynamic pathophysiology of different AS states. KEY POINTS: Reduction in the aortic valve area, flow across the aortic valve, and direction of the aortic stenosis jet determine the pressure gradient generated across the aortic valve in patients with aortic stenosis. Discordance between echo and catheterization maximum gradients is related to the inherent temporal differences between the times of their acquisition. Discordance between echo and catheterization mean gradients is related to pressure recovery and assumptions in the application of Bernoulli equation to estimate the aortic valve gradient. Pressure recovery relates to the ratio of the aortic valve area and ascending aortic diameter as well as the jet direction. Mismatch between area and gradient criteria for aortic stenosis severity may occur with or without concordance between echocardiographic and catheterization data. Errors of measurement should be excluded prior to assuming any mismatch or discordance between the data. Area gradient mismatch occurs when the aortic valve area is in the severe range, while the gradient is in the non-severe range as in low flow low gradient aortic stenosis. Reverse area gradient mismatch occurs when the gradient is in the severe range, while the aortic valve area is in the non-severe range as in congenital aortic stenosis with an eccentric jet.
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Affiliation(s)
- Amr E Abbas
- Department of Cardiovascular Medicine, Beaumont Health, Royal Oak, Michigan.,Department of Internal Medicine, Oakland University William Beaumont School of Medicine, Auburn Hills, Michigan
| | - Philippe Pibarot
- Department of Medicine, Laval University, Quebec City, QC, Canada
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Echocardiographic Follow-Up of Congenital Aortic Valvular Stenosis II. Pediatr Cardiol 2018; 39:1547-1553. [PMID: 29980825 DOI: 10.1007/s00246-018-1928-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 06/06/2018] [Indexed: 10/28/2022]
Abstract
We evaluated the natural course of congenital aortic valvular stenosis (AVS) and factors affecting AVS progression during long-term follow-up with echocardiography. Medical records of 388 patients with AVS were reviewed; patients with concomitant lesions other than aortic regurgitation (AR) were excluded. Trivial AVS was defined as a transvalvular Doppler peak systolic instantaneous gradient of < 25 mmHg; mild stenosis, 25-49 mmHg; moderate stenosis, 50-75 mmHg; and severe stenosis, > 75 mmHg. Median age of the patients was 3 years (range 0 day to 21 years), and 287 (74%) were male. A total of 355 patients were followed with medical treatment alone for a median of 4.6 years (range 1 month to 20.6 years), and the degree of AVS increased in 75 (21%) patients. The risk of AVS progression was higher when AVS was diagnosed in neonates (OR 4.29, CI 1.81-10.18, p = 0.001) and infants (OR 3.79, CI 2.21-6.49, p = 0.001). After the infancy period, bicuspid valve morphology increased AVS progression risk (OR 2.4, CI 1.2-4.6, p = 0.034). Patients with moderate AVS were more likely to have AVS progression (OR 2.59, CI 1.3-5.1, p = 0.006). Bicuspid valve morphology increased risk of AR development/progression (OR 1.77, CI 1.1-2.7, p = 0.017). The patients with mild and moderate AVS were more likely to have AR development/progression (p = 0.001). The risk of AR development/progression was higher in patients with AVS progression (OR 2.25, CI 1.33-3.81, p = 0.002). Newborn babies and infants should be followed more frequently than older patients according to disease severity. Bicuspid aortic valve morphology and moderate stenosis are risk factors for the progression of AVS and AR.
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Boe BA, Norris MD, Zampi JD, Rocchini AP, Ensing GJ. Temporal relationship between instantaneous pressure gradients and peak-to-peak systolic ejection gradient in congenital aortic stenosis. CONGENIT HEART DIS 2017; 12:733-739. [DOI: 10.1111/chd.12514] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 06/14/2017] [Accepted: 06/26/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Brian A. Boe
- Nationwide Children's Hospital; The Heart Center; Columbus Ohio USA
| | - Mark D. Norris
- University of Michigan C.S. Mott Children's Hospital Congenital Heart Center; Ann Arbor Michigan USA
| | - Jeffrey D. Zampi
- University of Michigan C.S. Mott Children's Hospital Congenital Heart Center; Ann Arbor Michigan USA
| | - Albert P. Rocchini
- University of Michigan C.S. Mott Children's Hospital Congenital Heart Center; Ann Arbor Michigan USA
| | - Gregory J. Ensing
- University of Michigan C.S. Mott Children's Hospital Congenital Heart Center; Ann Arbor Michigan USA
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Cantinotti M, Giordano R, Emdin M, Assanta N, Crocetti M, Marotta M, Iervasi G, Lopez L, Kutty S. Echocardiographic assessment of pediatric semilunar valve disease. Echocardiography 2017; 34:1360-1370. [DOI: 10.1111/echo.13527] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Massimiliano Cantinotti
- Foundation G. Monasterio CNR-Regione Toscana; Massa Pisa Italy
- Institute of Clinical Physiology; Pisa Italy
| | | | - Michele Emdin
- Foundation G. Monasterio CNR-Regione Toscana; Massa Pisa Italy
| | - Nadia Assanta
- Foundation G. Monasterio CNR-Regione Toscana; Massa Pisa Italy
| | - Maura Crocetti
- Foundation G. Monasterio CNR-Regione Toscana; Massa Pisa Italy
| | - Marco Marotta
- Foundation G. Monasterio CNR-Regione Toscana; Massa Pisa Italy
| | - Giorgio Iervasi
- Foundation G. Monasterio CNR-Regione Toscana; Massa Pisa Italy
- Institute of Clinical Physiology; Pisa Italy
| | - Leo Lopez
- Miami Children's Hospital; Miami FL USA
| | - Shelby Kutty
- University of Nebraska Medical Center; Children's Hospital and Medical Center; Omaha NE USA
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Correction of Doppler Gradients for Pressure Recovery Improves Agreement with Subsequent Catheterization Gradients in Congenital Aortic Stenosis. J Am Soc Echocardiogr 2015; 28:1410-7. [DOI: 10.1016/j.echo.2015.08.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Indexed: 11/21/2022]
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Falahatpisheh A, Rickers C, Gabbert D, Heng EL, Stalder A, Kramer HH, Kilner PJ, Kheradvar A. Simplified Bernoulli's method significantly underestimates pulmonary transvalvular pressure drop. J Magn Reson Imaging 2015; 43:1313-9. [PMID: 26584006 DOI: 10.1002/jmri.25097] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 11/03/2015] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To determine whether neglecting the flow unsteadiness in simplified Bernoulli's equation significantly affects the pulmonary transvalvular pressure drop estimation. MATERIALS AND METHODS 3.0T magnetic resonance imaging (MRI) 4D velocity mapping was performed on four healthy volunteers, seven patients with repaired tetralogy of Fallot, and thirteen patients with transposition of the great arteries repaired by arterial switch. Pulmonary transvalvular pressure drop was estimated based on two methods: General Bernoulli's Equation (GBE), ie, the most complete form; and Simplified Bernoulli's Equation (SBE), known as 4V(2) . More than 2300 individual pressure drop measurements were used to compare the simplified and the general Bernoulli's methods. A linear mixed-effects model was employed for statistical analyses, fully accounting for clustering of observations among the methods and systolic phases. RESULTS The simplified Bernoulli's method systematically underestimated the pressure drop compared to general Bernoulli's method during the entire systolic phase (P < 0.05), including the peak systole, where on average ΔpSBE/ΔpGBE=78%. CONCLUSION The simplified Bernoulli method underestimated the pressure drop during all systolic phases in all the studied subjects. Therefore, it is necessary to take into account the flow unsteadiness for more accurate estimation of the pressure drop. J. Magn. Reson. Imaging 2016;43:1313-1319.
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Affiliation(s)
- Ahmad Falahatpisheh
- University of California Irvine, Department of Biomedical Engineering, Edwards Lifesciences Center of Advanced Cardiovascular Technology; Irvine California USA
| | - Carsten Rickers
- University Hospital Schleswig-Holstein Campus Kiel, Department of Pediatric Cardiology; Kiel Germany
| | - Dominik Gabbert
- University Hospital Schleswig-Holstein Campus Kiel, Department of Pediatric Cardiology; Kiel Germany
| | - Ee Ling Heng
- Royal Brompton Hospital, London, UK, NIHR Cardiovascular Biomedical Research Unit of Royal Brompton and Harefield NHS Foundation Trust and Imperial College; London UK
| | | | - Hans-Heiner Kramer
- University Hospital Schleswig-Holstein Campus Kiel, Department of Pediatric Cardiology; Kiel Germany
| | - Philip J. Kilner
- Royal Brompton Hospital, London, UK, NIHR Cardiovascular Biomedical Research Unit of Royal Brompton and Harefield NHS Foundation Trust and Imperial College; London UK
| | - Arash Kheradvar
- University of California Irvine, Department of Biomedical Engineering, Edwards Lifesciences Center of Advanced Cardiovascular Technology; Irvine California USA
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Abstract
BACKGROUND Aortic arch obstruction can be evaluated by catheter peak-to-peak gradient or by Doppler peak instantaneous pressure gradient. Previous studies have shown moderate correlation in discrete coarctation, but few have assessed correlation in patients with more complex aortic reconstruction. METHODS We carried out retrospective comparison of cardiac catheterisations and pre- and post-catheterisation echocardiograms in 60 patients with native/recurrent coarctation or aortic reconstruction. Aortic arch obstruction was defined as peak-to-peak gradient ⩾25 mmHg in patients with native/recurrent coarctation and ⩾10 mmHg in aortic reconstruction. RESULTS Diastolic continuation of flow was not associated with aortic arch obstruction in either group. Doppler peak instantaneous pressure gradient, with and without the expanded Bernoulli equation, weakly correlated with peak-to-peak gradient even in patients with a normal cardiac index (r=0.36, p=0.016, and r=0.49, p=0.001, respectively). Receiver operating characteristic curve analysis identified an area under the curve of 0.61 for patients with all types of obstruction, with a cut-off point of 45 mmHg correctly classifying 64% of patients with arch obstruction (sensitivity 39%, specificity 89%). In patients with aortic arch reconstruction who had a cardiac index ⩾3 L/min/m², a cut-off point of 23 mmHg correctly classified 69% of patients (71% sensitivity, 50% specificity) with an area under the curve of 0.82. CONCLUSION The non-invasive assessment of aortic obstruction remains challenging. The greatest correlation of Doppler indices was noted in patients with aortic reconstruction and a normal cardiac index.
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Akgun T, Karabay CY, Kocabay G, Oduncu V, Kalayci A, Guler A, Ozveren O, Yilmaz F, Akcakoyun M, Kirma C. Discrepancies between Doppler and catheter gradients in ventricular septal defect: a correction of localized gradients from pressure recovery phenomenon. Int J Cardiovasc Imaging 2013; 30:39-45. [DOI: 10.1007/s10554-013-0291-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 09/05/2013] [Indexed: 10/26/2022]
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Recommendations for quantification methods during the performance of a pediatric echocardiogram: a report from the Pediatric Measurements Writing Group of the American Society of Echocardiography Pediatric and Congenital Heart Disease Council. J Am Soc Echocardiogr 2010; 23:465-95; quiz 576-7. [PMID: 20451803 DOI: 10.1016/j.echo.2010.03.019] [Citation(s) in RCA: 1086] [Impact Index Per Article: 77.6] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Simple Congenital Heart Defects. Echocardiography 2009. [DOI: 10.1007/978-1-84882-293-1_26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Clinical utility of Doppler echocardiography in assessing aortic stenosis severity and predicting need for intervention in children. Pediatr Cardiol 2008; 29:507-14. [PMID: 18080153 DOI: 10.1007/s00246-007-9169-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2007] [Revised: 11/04/2007] [Accepted: 11/17/2007] [Indexed: 10/22/2022]
Abstract
The optimal echocardiographic methodology for predicting need for intervention in children with valvar aortic stenosis (VAS) is not known. We reviewed echocardiograms and catheterization reports of 79 children (aged 9.5 +/- 5.9 years) with isolated VAS. The maximum and mean Doppler-predicted gradients from the apical (MIGAP), MEGAP)) and the suprasternal or right parasternal (MIGHP), MEGHP)) windows were measured. The peak-to-peak catheterization gradient and the intervention (if any) were recorded. All sites and methods of Doppler estimation of VAS gradient correlated in a linear fashion with the invasive gradient (R2 = 0.34-0.50) and with one another (R2 = 0.48-0.86). MIGAP and MIGHP overestimated the invasive gradient in 60% and 86% of patients, whereas MEGAP and MEGHP underestimated the invasive gradient in 94% and 83% of patients, respectively. Age and diameter of the ascending aorta had small but significant effects on the level of agreement. A MIGHP < or = 55 mm Hg predicted no intervention with 100% accuracy, whereas the specificities of a MIGHP > 90 mm Hg, a MEGAP > 50 mm Hg, and a (MIGAP + MIGHP)/2 > 70 mm Hg for intervention were 94%, 100%, and 92%, respectively. The magnitude of overestimation was significantly lower from the apical window. In children with VAS, the best prediction of the catheterization gradient could be based on the average of MIGAP and MIGHP.
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Spevack DM, Almuti K, Ostfeld R, Bello R, Gordon GM. Routine Adjustment of Doppler Echocardiographically Derived Aortic Valve Area Using a Previously Derived Equation to Account for the Effect of Pressure Recovery. J Am Soc Echocardiogr 2008; 21:34-7. [PMID: 17764899 DOI: 10.1016/j.echo.2007.04.031] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2007] [Indexed: 11/25/2022]
Affiliation(s)
- Daniel M Spevack
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York 10467, USA.
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Eroglu AG, Babaoglu K, Saltik L, Oztunç F, Demir T, Ahunbay G, Guzeltas A, Cetin G. Echocardiographic follow-up of congenital aortic valvular stenosis. Pediatr Cardiol 2006; 27:713-9. [PMID: 17111293 DOI: 10.1007/s00246-006-1321-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2006] [Accepted: 07/18/2006] [Indexed: 11/27/2022]
Abstract
We investigated the morphology of the stenotic aortic valve, the progression of the stenosis, and the onset and progression of aortic regurgitation (AR) in patients with congenital aortic valvular stenosis (AVS). The medical records of 278 patients with AVS were reviewed, with the patients with concomitant lesions besides AR excluded. Very mild aortic stenosis was defined as a transvalvular Doppler peak systolic instantaneous gradient (PSIG) less than 25 mmHg, mild stenosis as 25-49 mmHg, moderate stenosis as 50-75 mmHg, and severe stenosis as more than 75 mmHg. The mean age of the patients was 4.9 +/- 4.3 years (range, 3 days to 15 years), and 203 (73%) were male. The number of the cusps was determined with two-dimensional echocardiography in 266 patients (95%): unicuspid in 3 patients (1%), bicuspid in 127 patients (48%), and tricuspid in 136 patients (51%). A total of 192 of all patients were followed for 2 months to 14.6 years (mean 4.2 +/- 3.3 years) with medical treatment alone. Among 72 patients with very mild stenosis at initial echocardiographic examination, 20% had mild, 3% moderate, and 1% severe stenosis after a mean period of 3.7 years. In 70 patients with mild stenosis at initial echocardiographic examination, 28% had moderate and 9% severe stenosis after a mean period of 5 years. Among 44 patients with moderate stenosis at initial echocardiographic examination, 36% had severe stenosis after a mean period of 3.7 years. Among 192 patients, 40% had AR (3% trivial, 28% mild, and 9% moderate) at initial echocardiographic examination. After a mean period of 4.2 years, 58% of the patients had AR (13 % trivial, 25% mild, 16% moderate, and 4% severe). There was not statistically significant difference between catheterization peak systolic gradients (47 +/- 16 mmHg) and Doppler estimated mean gradients (45 +/- 9 mmHg) (p = 0.53), whereas Doppler PSIGs (74.9 +/- 15.7 mmHg) were higher than catheterization peak systolic gradients (p < 0.0001) in 25 patients who were studied in the catheterization lab. Patients with very mild stenosis may be followed with a noninvasive approach every 1 or 2 years, and an annual follow-up is suggested for patients with mild stenosis. Nearly one-third of patients with moderate stenosis at initial echocardiographic examination had severe stenosis after a mean period of 3.7 years. Therefore, we recommend, that patients with moderate stenosis undergo noninvasive evaluation every 6 months. Doppler estimated mean gradient is very useful in predicting the need for intervention in children with AVS.
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Affiliation(s)
- Ayse Guler Eroglu
- Division of Pediatric Cardiology, Department of Pediatrics, Istanbul University Cerrahpaşa Medical Faculty, 80303, Aksaray, Istanbul, Turkey.
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Abstract
When evaluating congenital heart disease, echocardiography is a powerful diagnostic tool. The availability, mobility, diagnostic accuracy, and noninvasive nature of echocardiography provide distinct advantages over other diagnostic modalities such as cardiac catheterization. Pediatric echocardiography has distinct differences from echocardiography performed on adults. First, the scanning techniques employed are tailored to the smaller size and younger age of the pediatric age group. Second, the types of diseases for which echocardiography is employed are necessarily different and usually consist of complex congenital lesions.
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Affiliation(s)
- Sandra A. Witt
- Society for Diagnostic Medical Sonography, c/o Dawn Sanchez, 2745 North Dallas Parkway, Suite 350, Plano, TX75093,
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Tempe DK, Datt V, Banerjee A, Goel S, Arora D, Tomar AS, Shanewise JS, DiNardo JA. Case 5—2004. J Cardiothorac Vasc Anesth 2004; 18:657-62. [PMID: 15578482 DOI: 10.1053/j.jvca.2004.07.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Deepak K Tempe
- Department of Anaesthesiology, G.B. Pant Hospital, New Delhi, India.
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