Echocardiographic estimation of pulmonary artery pressure in infants and children with congenital heart disease.

Abstract

Echocardiography was used to study the quantitative and qualitative alterations of pulmonary valve echograms. 228 infants and children with congenital heart disease and with known pulmonary artery pressure were studied to evaluate which echocardiographic parameters would be most useful in predicting pulmonary artery hypertension. Right ventricular systolic time intervals (RVSTI) were studied and when patients with complete right bundle branch block (CRBBB) or transposition of the great arteries (TGA) had been excluded the strongest correlation was found between right ventricular preejection period/right ventricular ejection time (RPEP/RVET) and pulmonary artery diastolic pressure (PADP) (r = 0.73). In patients with TGA the correlation coefficient for LPEP/LVET and PADP was r = 0.88. We did not find a significant correlation between right ventricular isovolumetric contraction time (RICT) or RICT/RVET and PADP in patients with CRBBB. The correlation between the amplitude of the a-wave and PADP was fair (r = 0.48). BC slope, EF slope and the maximum amplitude of opening of the pulmonary valve were all related to PADP but the correlation coefficients were low. A-wave of 2 mm or less, systolic fluttering or systolic notching of the pulmonary valve echo were seen significantly more often in patients with PADP above 20 mm Hg but were less valuable in predicting pulmonary artery hypertension. RVSTI seem to be more useful than the other echocardiographic parameters for evaluation of pulmonary artery hypertension and RPEP/RVET appears to be the most reliable of them.