1
|
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.
Collapse
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
| |
Collapse
|
2
|
Dellas C, Kammerer L, Gravenhorst V, Lotz J, Paul T, Steinmetz M. Quantification of pulmonary regurgitation and prediction of pulmonary valve replacement by echocardiography in patients with congenital heart defects in comparison to cardiac magnetic resonance imaging. Int J Cardiovasc Imaging 2017; 34:607-613. [DOI: 10.1007/s10554-017-1267-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 10/31/2017] [Indexed: 02/05/2023]
|
3
|
Diagnostic value of Doppler echocardiography for identifying hemodynamic significant pulmonary valve regurgitation in tetralogy of Fallot: comparison with cardiac MRI. Int J Cardiovasc Imaging 2017; 33:1723-1730. [PMID: 28567705 PMCID: PMC5682867 DOI: 10.1007/s10554-017-1165-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 05/08/2017] [Indexed: 12/01/2022]
Abstract
Quantification of pulmonary regurgitation (PR) is essential in the management of patients with repaired tetralogy of Fallot (TOF). We sought to evaluate the accuracy of first-line Doppler echocardiography in comparison with cardiac magnetic resonance imaging (MRI) to identify hemodynamic significant PR. Paired cardiac MRI and echocardiographic studies (n = 97) in patients with repaired TOF were retrospectively analyzed. Pressure half time (PHT) and pulmonary regurgitation index (PRi) were measured using continuous wave Doppler. The ratio of the color flow Doppler regurgitation jet width to pulmonary valve (PV) annulus (jet/annulus ratio) and diastolic to systolic time velocity integral (DSTVI; pulsed wave Doppler) were assessed. Accuracy of echocardiographic measurements was tested to identify significant PR as determined by phase-contrast MRI (PR fraction [PRF] ≥ 20%). Mean PRF was 29.4 ± 15.7%. PHT < 100 ms had a sensitivity of 93%, specificity 75%, positive predictive value (PPV) 92% and negative predictive value (NPV) 78% for identifying significant PR (C-statistic 0.82). PRi < 0.77 had sensitivity and specificity of 66% and 54%, respectively (C-statistic 0.63). Jet/annulus ratio ≥1/3 had sensitivity 96%, specificity 75%, PPV 92% and NPV 82% (C-statistic 0.87). DSTVI had sensitivity 84%, specificity 33%, PPV 84% and NPV 40%, (C-statistic 0.56). Combined jet/annulus ratio ≥1/3 and PHT < 100 ms was highly accurate in identifying PRF ≥ 20%, with sensitivity 97% and specificity 100%. PHT and jet/annulus ratio on Doppler echocardiography, especially when combined, are highly accurate in identifying significant PR and therefore seem useful in the follow-up of patients with repaired TOF.
Collapse
|
4
|
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
| |
Collapse
|
5
|
Daraban AM, Jurcuţ R, Bădilă E, Bartoş D, Dan GA. Following up adult patients with tetralogy of fallot: The role of echocardiography. JOURNAL OF CLINICAL ULTRASOUND : JCU 2017; 45:79-95. [PMID: 27861982 DOI: 10.1002/jcu.22411] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Revised: 07/14/2016] [Accepted: 08/22/2016] [Indexed: 06/06/2023]
Abstract
Tetralogy of Fallot (TOF) is one of the most common cyanotic congenital heart diseases. With surgical repair and the advances in postoperative care, contemporary mortality has dramatically improved and an increasing number of patients survive into adulthood, leading to a growing number of adult TOF. However, residual anatomic and hemodynamic abnormalities are encountered in nearly all patients, making follow-up mandatory. Furthermore, mortality starts to increase 25 years after surgery, emphasizing that, in adult TOF, closer monitoring is necessary. We review here the role of echocardiography in the follow-up of the TOF patients, emphasizing the role of multiple echocardiographic techniques. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45:79-95, 2017.
Collapse
Affiliation(s)
- Ana Maria Daraban
- 'Carol Davila' University of Medicine and Pharmacy, Bucharest, Romania
- Clinical Emergency Hospital, Bucharest, Romania
| | - Ruxandra Jurcuţ
- 'Carol Davila' University of Medicine and Pharmacy, Bucharest, Romania
- 'C.C. Iliescu' Emergency Institute for Cardiovascular Diseases, Bucharest, Romania
| | - Elisabeta Bădilă
- 'Carol Davila' University of Medicine and Pharmacy, Bucharest, Romania
- Clinical Emergency Hospital, Bucharest, Romania
| | - Daniela Bartoş
- 'Carol Davila' University of Medicine and Pharmacy, Bucharest, Romania
- Clinical Emergency Hospital, Bucharest, Romania
| | - Gheorghe Andrei Dan
- 'Carol Davila' University of Medicine and Pharmacy, Bucharest, Romania
- Colentina Clinical Hospital, Bucharest, Romania
| |
Collapse
|
6
|
Shillcutt SK, Tavazzi G, Shapiro BP, Diaz-Gomez J. Pulmonic Regurgitation in the Adult Cardiac Surgery Patient. J Cardiothorac Vasc Anesth 2016; 31:215-228. [PMID: 27712967 DOI: 10.1053/j.jvca.2016.06.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Sasha K Shillcutt
- Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE.
| | - Guido Tavazzi
- Department of Anesthesia and Intensive Care, Emergency Medicine, University of Pavia Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Jose Diaz-Gomez
- Department of Critical Care Medicine, Anesthesiology, and Neurosurgery, Mayo Clinic, Jacksonville, FL
| |
Collapse
|
7
|
Bussadori C, Salvo GD, Pluchinotta FR, Piazza L, Gaio G, Russo MG, Carminati M. Evaluation of Right Ventricular Function in Adults with Congenital Heart Defects. Echocardiography 2014; 32 Suppl 1:S38-52. [DOI: 10.1111/echo.12566] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Claudio Bussadori
- Pediatric Cardiology and Adult with Congenital Heart Disease Department; IRCCS San Donato Hospital; Milan Italy
| | - Giovanni Di Salvo
- Heart Institute; Pediatric Cardiology; King Faisal Specialist Hospital and Research Center; Riyadh Saudi Arabia
| | - Francesca R. Pluchinotta
- Pediatric Cardiology and Adult with Congenital Heart Disease Department; IRCCS San Donato Hospital; Milan Italy
| | - Luciane Piazza
- Pediatric Cardiology and Adult with Congenital Heart Disease Department; IRCCS San Donato Hospital; Milan Italy
| | - Giampiero Gaio
- Department of Cardiology; Division of Pediatric Cardiology; Second University of Naples-Monaldi Hospital; Naples Italy
| | - Maria Giovanna Russo
- Department of Cardiology; Division of Pediatric Cardiology; Second University of Naples-Monaldi Hospital; Naples Italy
| | - Mario Carminati
- Pediatric Cardiology and Adult with Congenital Heart Disease Department; IRCCS San Donato Hospital; Milan Italy
| |
Collapse
|
8
|
Senthilnathan S, Dragulescu A, Mertens L. Pulmonary Regurgitation after Tetralogy of Fallot Repair: A Diagnostic and Therapeutic Challenge. J Cardiovasc Echogr 2013; 23:1-9. [PMID: 28465877 PMCID: PMC5353440 DOI: 10.4103/2211-4122.117975] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Pulmonary regurgitation is the key hemodynamically significant lesion in repaired tetralogy of Fallot contributing to progressive right ventricular (RV) dilatation and biventricular dysfunction. The timing for pulmonary valve replacement remains a controversial topic, and the decision to intervene depends on assessment of RV size and RV function. OBJECTIVES This review aims to discuss the echocardiographic techniques that can be used to assess patients with pulmonary regurgitation after the repair of tetralogy of Fallot defect. While cardiac magnetic resonance (CMR) imaging is the clinical reference method, there is an important role of echocardiography in identifying patients with significant pulmonary regurgitation and assessing the RV size and function. The different echocardiographic techniques that can be used in this context are discussed. Newer techniques for assessing RV size and function include three-dimensional (3D) echocardiography, tissue Doppler and strain imaging. 3D RV volumetric reconstruction based on two-dimensional imaging is a promising new technique that could potentially replace CMR for RV volumetric assessment. CONCLUSIONS Developments in echocardiographic techniques provide new insights into the impact of pulmonary regurgitation on RV structure and function. Echocardiography and CMR are complementary modalities and further research is required to define the optimal use of both techniques for this indication.
Collapse
Affiliation(s)
- Selvi Senthilnathan
- The Labatt Family Heart Center, the Hospital for Sick Children, University of Toronto. Toronto, ON, Canada
| | - Andreea Dragulescu
- The Labatt Family Heart Center, the Hospital for Sick Children, University of Toronto. Toronto, ON, Canada
| | - Luc Mertens
- The Labatt Family Heart Center, the Hospital for Sick Children, University of Toronto. Toronto, ON, Canada
| |
Collapse
|
9
|
Mercer-Rosa L, Yang W, Kutty S, Rychik J, Fogel M, Goldmuntz E. Quantifying pulmonary regurgitation and right ventricular function in surgically repaired tetralogy of Fallot: a comparative analysis of echocardiography and magnetic resonance imaging. Circ Cardiovasc Imaging 2012; 5:637-43. [PMID: 22869820 DOI: 10.1161/circimaging.112.972588] [Citation(s) in RCA: 103] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patients with repaired tetralogy of Fallot are monitored for pulmonary regurgitation (PR) and right ventricular (RV) function. We sought to compare measures of PR and RV function on echocardiogram to those on cardiac magnetic resonance (CMR) and to develop a new tool for assessing PR by echocardiogram. METHODS AND RESULTS Patients with repaired tetralogy of Fallot (n=143; 12.5±3.2 years) had an echocardiogram and CMR within 3 months of each other. On echocardiogram, RV function was assessed by (1) Doppler tissue imaging of the RV free wall and (2) myocardial performance index. The ratio of diastolic and systolic time-velocity integrals measured by Doppler of the main pulmonary artery was calculated. CMR variables included RV ejection fraction, RV volumes, and pulmonary regurgitant fraction (RF). Pulmonary regurgitation was graded as mild (RF<20%), moderate (RF=20-40%), and severe (RF>40%). On CMR, RF was 34+17% and RV ejection fraction was 61+8%. Echocardiography had good sensitivity identifying cases with RF>20% (sensitivity 97%; 95% CI: 92-99%) but overestimated the amount of PR when RF<20% (false-positive rate 36%; 95% CI: 18-57%). The diastolic and systolic time-velocity integrals on echocardiogram showed moderate correlation with RF on CMR (R=0.60; P<0.0001). On CMR, RF of 20% and 40% corresponded with a diastolic and systolic time-velocity integral of 0.49 (95% CI: 0.44-0.56) and 0.72 (95% CI: 0.68-0.76), respectively. RV myocardial performance index correlated modestly with RV ejection fraction (r=-0.33; P<0.001). CONCLUSIONS This study suggests that the diastolic and systolic time-velocity integrals ratio may make a modest contribution to the overall assessment of PR in patients with repaired tetralogy of Fallot and warrants further investigation. However, echocardiography continues to have a limited ability to quantify PR and RV function as compared with CMR.
Collapse
Affiliation(s)
- Laura Mercer-Rosa
- Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine, 34th and Civic Center Blvd, Philadelphia, PA 19104, USA.
| | | | | | | | | | | |
Collapse
|
10
|
Abstract
Transesophageal echocardiography (TEE) plays an important role in the anatomical, functional, and hemodynamic assessment of patients with congenital heart disease (CHD). This imaging approach has been applied to both children and adults with a wide range of cardiovascular malformations. Extensive clinical experience documents significant contributions, particularly in the perioperative setting. In fact, in the current medical era, many consider this technology to be an essential adjunct to surgical and anesthetic management in CHD. This review focuses on the applications of TEE in patients with tetralogy of Fallot (TOF), the most common form of cyanotic heart disease. Emphasis is given to the perioperative use of this imaging modality and benefits derived during the prebypass and postbypass periods. Limitations and pitfalls relevant to the TEE assessment in patients with this anomaly are also addressed.
Collapse
|
11
|
Transpulmonary arterial repair of type 1 ventricular septal defect will induce pulmonary regurgitation: Appraisal of subpulmonic approach. J Thorac Cardiovasc Surg 2011; 142:1388-92. [DOI: 10.1016/j.jtcvs.2011.06.009] [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: 11/16/2010] [Revised: 04/18/2011] [Accepted: 06/07/2011] [Indexed: 10/18/2022]
|
12
|
Two-Dimensional and Doppler Echocardiography Reliably Predict Severe Pulmonary Regurgitation as Quantified by Cardiac Magnetic Resonance. J Am Soc Echocardiogr 2010; 23:880-6. [DOI: 10.1016/j.echo.2010.05.019] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2009] [Indexed: 11/24/2022]
|
13
|
Complete destruction of a tissue-engineered porcine xenograft in pulmonary valve position after the Ross procedure. J Thorac Cardiovasc Surg 2010; 139:e67-8. [DOI: 10.1016/j.jtcvs.2008.12.033] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2008] [Revised: 11/13/2008] [Accepted: 12/30/2008] [Indexed: 02/07/2023]
|