Table 2.
| Echocardiographic parameter | Comment |
|---|---|
| Disproportionately large right side of the heart with right ventricle (RV) hypertrophy and / or RV dilatation on visual inspection | In multiple views on visual inspection “eyeballing” shows cardiac asymmetry with right ride of the heart bigger than left side |
| Estimation of pulmonary artery systolic pressure (PASP) | By using tricuspid gradient (when present) or ductal shunt – Doppler assessment |
| Direction of blood flow across patent ductus arteriosus (PDA) |
Right to left shunt: supra-systemic pulmonary artery pressure (PAP) Left to right shunt: sub-systemic PAP Bidirectional shunt: PAP equal to systemic blood pressure |
| Direction of blood flow across patent foramen ovale (PFO) | Often it’s bidirectional and seldom purely right to left |
| Flattening of interventricular septum (due to sustained high pressure in the right ventricle and flattening proportional to severity of PPHN | Helps in estimating severity of PPHN in absence of TR or PDA; can be categorized as mild, moderate and severe flattening |
| Assessment of right ventricle function | On visual inspection Tricuspid annular pan systolic excursion (TAPSE) Tei index using Tissue Doppler Imaging (TDI) |
| Assessment of left ventricle function | On visual inspection Tei index using Tissue Doppler Imaging (TDI) (note fraction shortening may be unreliable in presence of RV hypertrophy and dysfunction) |
| Assessment of cardiac filling (preload) | IVC size and collapsibility |
| Advanced echocardiography and hemodynamic evaluation | RV fractional area change PAAT and PAAT/RVET ratio Speckle tracking and strain rate Estimation of left and right cardiac output and serial assessment to see the response to therapy |