Skip to main content
Archives of Disease in Childhood logoLink to Archives of Disease in Childhood
. 1993 Aug;69(2):216–220. doi: 10.1136/adc.69.2.216

Right heart pressure determination by Doppler in infants with tricuspid regurgitation.

J R Skinner 1, A G Stuart 1, J O'Sullivan 1, A Heads 1, R J Boys 1, S Hunter 1
PMCID: PMC1029460  PMID: 8215524

Abstract

Doppler and direct measurements of right ventricle to right atrial pressure drop were made during cardiac catheterisation on 28 occasions in 26 infants with congenital heart disease. Age was 10 days to 12 months (median 4.5 months), and weight was 3.1 to 9.0 kg (median 4.7 kg). We measured peak velocity of tricuspid regurgitation by continuous wave Doppler, and the pressure drop was calculated using the modified Bernoulli equation (delta p = 4v2). There was a high correlation (r = 0.95) between direct and Doppler measurements. Doppler values tended to underestimate the right ventricle to right atrial pressure drop, but this was not of clinical significance (mean 2 mm Hg). The 95% confidence interval for the Doppler velocity was -0.41 to +0.26 m/sec, and was consistent across the range of pressures studied. Variability between observers was tested, by two observers performing sequential paired examinations on 16 newborn babies with tricuspid regurgitation. The coefficient of repeatability was 6.3 mm Hg (95% confidence interval 4.7 to 9.5 mm Hg) or 0.26 m/sec (0.18 to 0.50 m/sec). This method of right ventricular pressure estimation, validated previously only in older children and adults, is a reproducible and accurate technique in infants with tricuspid regurgitation.

Full text

PDF
219

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Beard J. T., 2nd, Byrd B. F., 3rd Saline contrast enhancement of trivial Doppler tricuspid regurgitation signals for estimating pulmonary artery pressure. Am J Cardiol. 1988 Sep 1;62(7):486–488. doi: 10.1016/0002-9149(88)90989-7. [DOI] [PubMed] [Google Scholar]
  2. Berger M., Haimowitz A., Van Tosh A., Berdoff R. L., Goldberg E. Quantitative assessment of pulmonary hypertension in patients with tricuspid regurgitation using continuous wave Doppler ultrasound. J Am Coll Cardiol. 1985 Aug;6(2):359–365. doi: 10.1016/s0735-1097(85)80172-8. [DOI] [PubMed] [Google Scholar]
  3. Bland J. M., Altman D. G. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986 Feb 8;1(8476):307–310. [PubMed] [Google Scholar]
  4. Chan K. L., Currie P. J., Seward J. B., Hagler D. J., Mair D. D., Tajik A. J. Comparison of three Doppler ultrasound methods in the prediction of pulmonary artery pressure. J Am Coll Cardiol. 1987 Mar;9(3):549–554. doi: 10.1016/s0735-1097(87)80047-5. [DOI] [PubMed] [Google Scholar]
  5. Currie P. J., Seward J. B., Chan K. L., Fyfe D. A., Hagler D. J., Mair D. D., Reeder G. S., Nishimura R. A., Tajik A. J. Continuous wave Doppler determination of right ventricular pressure: a simultaneous Doppler-catheterization study in 127 patients. J Am Coll Cardiol. 1985 Oct;6(4):750–756. doi: 10.1016/s0735-1097(85)80477-0. [DOI] [PubMed] [Google Scholar]
  6. Gallet B., Saudemont J. P., Bourdon D., Bayet G., Babo P., Thenault D., Adams C., Accard J. L., Hiltgen M. Evaluation de l'hypertension artérielle pulmonaire par échocardiographie doppler dans l'insuffisance respiratoire chronique. Arch Mal Coeur Vaiss. 1989 Sep;82(9):1575–1583. [PubMed] [Google Scholar]
  7. Hirschfeld S., Meyer R., Schwartz D. C., Kofhagen J., Kaplan S. The echocardiographic assessment of pulmonary artery pressure and pulmonary vascular resistance. Circulation. 1975 Oct;52(4):642–650. doi: 10.1161/01.cir.52.4.642. [DOI] [PubMed] [Google Scholar]
  8. Holen J., Aaslid R., Landmark K., Simonsen S., Ostrem T. Determination of effective orifice area in mitral stenosis from non-invasive ultrasound Doppler data and mitral flow rate. Acta Med Scand. 1977 Jan;201(1-2):83–88. doi: 10.1111/j.0954-6820.1977.tb15660.x. [DOI] [PubMed] [Google Scholar]
  9. Houston A. B., Lim M. K., Doig W. B., Reid J. M., Coleman E. N. Doppler assessment of the interventricular pressure drop in patients with ventricular septal defects. Br Heart J. 1988 Jul;60(1):50–56. doi: 10.1136/hrt.60.1.50. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Kosturakis D., Goldberg S. J., Allen H. D., Loeber C. Doppler echocardiographic prediction of pulmonary arterial hypertension in congenital heart disease. Am J Cardiol. 1984 Apr 1;53(8):1110–1115. doi: 10.1016/0002-9149(84)90646-5. [DOI] [PubMed] [Google Scholar]
  11. Laaban J. P., Diebold B., Zelinski R., Lafay M., Raffoul H., Rochemaure J. Noninvasive estimation of systolic pulmonary artery pressure using Doppler echocardiography in patients with chronic obstructive pulmonary disease. Chest. 1989 Dec;96(6):1258–1262. doi: 10.1378/chest.96.6.1258. [DOI] [PubMed] [Google Scholar]
  12. Serwer G. A., Cougle A. G., Eckerd J. M., Armstrong B. E. Factors affecting use of the Doppler-determined time from flow onset to maximal pulmonary artery velocity for measurement of pulmonary artery pressure in children. Am J Cardiol. 1986 Aug 1;58(3):352–356. doi: 10.1016/0002-9149(86)90076-7. [DOI] [PubMed] [Google Scholar]
  13. Skinner J. R., Boys R. J., Hunter S., Hey E. N. Non-invasive assessment of pulmonary arterial pressure in healthy neonates. Arch Dis Child. 1991 Apr;66(4 Spec No):386–390. doi: 10.1136/adc.66.4_spec_no.386. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Skinner J. R., Boys R. J., Hunter S., Hey E. N. Pulmonary and systemic arterial pressure in hyaline membrane disease. Arch Dis Child. 1992 Apr;67(4 Spec No):366–373. doi: 10.1136/adc.67.4_spec_no.366. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Skinner J. R., Milligan D. W., Hunter S., Hey E. N. Central venous pressure in the ventilated neonate. Arch Dis Child. 1992 Apr;67(4 Spec No):374–377. doi: 10.1136/adc.67.4_spec_no.374. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Skjaerpe T., Hatle L. Noninvasive estimation of systolic pressure in the right ventricle in patients with tricuspid regurgitation. Eur Heart J. 1986 Aug;7(8):704–710. doi: 10.1093/oxfordjournals.eurheartj.a062126. [DOI] [PubMed] [Google Scholar]
  17. Stevenson J. G. Comparison of several noninvasive methods for estimation of pulmonary artery pressure. J Am Soc Echocardiogr. 1989 May-Jun;2(3):157–171. doi: 10.1016/s0894-7317(89)80053-7. [DOI] [PubMed] [Google Scholar]
  18. Tramarin R., Torbicki A., Marchandise B., Laaban J. P., Morpurgo M. Doppler echocardiographic evaluation of pulmonary artery pressure in chronic obstructive pulmonary disease. A European multicentre study. Working Group on Noninvasive Evaluation of Pulmonary Artery Pressure. European Office of the World Health Organization, Copenhagen. Eur Heart J. 1991 Feb;12(2):103–111. doi: 10.1093/oxfordjournals.eurheartj.a059855. [DOI] [PubMed] [Google Scholar]
  19. Vazquez de Prada J. A., Ruano J., Martin-Duran R., Larman M., Zueco J., Ortiz de Murua J. A., Torres A., Figueroa A. Noninvasive determination of pulmonary arterial systolic pressure by continuous wave Doppler. Int J Cardiol. 1987 Aug;16(2):177–184. doi: 10.1016/0167-5273(87)90249-x. [DOI] [PubMed] [Google Scholar]
  20. Yock P. G., Popp R. L. Noninvasive estimation of right ventricular systolic pressure by Doppler ultrasound in patients with tricuspid regurgitation. Circulation. 1984 Oct;70(4):657–662. doi: 10.1161/01.cir.70.4.657. [DOI] [PubMed] [Google Scholar]

Articles from Archives of Disease in Childhood are provided here courtesy of BMJ Publishing Group

RESOURCES