Normal Values and Patterns of Normality and Physiological Variability of Mitral and Tricuspid Inflow Pulsed Doppler in Healthy Children.

Massimiliano Cantinotti,Eliana Franchi,Shelby Kutty,Raffaele Giordano,Jef Van Den Eynde,Martin Koestenberger,Marco Scalese,Nadia Assanta,Pietro Marchese

doi:10.3390/healthcare10020355

Abstract

Background: While mitral (MV) and tricuspid valve (TV) pulsed Doppler velocities and derived gradients are commonly evaluated, data on normal pediatric values are limited. This study aimed to evaluate the normal values and physiological variability for MV and TV Doppler velocities and derived gradients in a large cohort of prospectively enrolled healthy children. Methods: The echocardiographic measurements included pulsed Doppler MV and TV E and A velocities, E deceleration times (EDT), maximal and mean gradients, and velocity time integral (VTI). Results: A total of 544 healthy subjects (median age 6.4 years, range 1 day–17.68 years) were included. MV and TV E velocity, E/A ratio, and E and A wave duration increased, while A velocity decreased with age (p < 0.001). Along with an increase in VTI, there occurred a progressive increase in maximum velocity and gradients and a decrease in mean velocities and gradients. E/A inversions were common, especially at the TV in neonates and infants. For MV, inversion in either one, two, or three consecutive beats occurred in 51.9% of neonates and 18.3% of infants, while it was rare at older ages (all p < 0.001). For TV, inversions in three consecutive beats occurred in 71.4% of neonates, while inversions in only one or two beats were more common in infants (27.3%). For TV, inversion in one or more beats, however, was not infrequent at all ages. Conclusions: We report normal values and patterns of normality and physiological variability for MV and TV inflow Doppler from a large population of healthy children.

Highlights

Cardiac inflow Doppler velocities and pressure gradients are sensitive echocardiographic indices of atrioventricular valve pathology and ventricular diastolic function [1,2]
Other exclusion criteria were: (i) known or suspected neuro-muscular disease, genetic syndromes, or chromosomal abnormalities; (ii) body mass index (BMI) ≥ 95th percentile for children ≥ 2 years old or weight-for-length Z-score ≥ 2 based on the World Health Organization (WHO) Child Growth Standards for children < 2 years old; (iii) pulmonary hypertension; (iv) systemic hypertension; (v) connective tissue disease; (vi) family history of genetic cardiac disease [18]
The subjects were divided into groups based on age: (1) neonates, 0 to 30 days, (2) infants, 1 to 24 months, (3) toddlers, 2 to 5 years, (4) children, 5 to 11 years, and (5) adolescents, 11 to 18 years

Summary

Introduction

Cardiac inflow Doppler velocities and pressure gradients are sensitive echocardiographic indices of atrioventricular valve pathology and ventricular diastolic function [1,2]. Few studies systematically quantifying pulsed wave Doppler velocities and pressure gradients have been reported in children, especially for the tricuspid valve (TV) [3,4]. Because of this limitation, pediatric cardiologists often apply adult nomograms clinically, which is inadequate. Other echocardiographic indices of inflow stenosis, including velocity time integrals (VTI) and Doppler-derived gradients, have not been studied [11,12,13,14,15,16,17]. While mitral (MV) and tricuspid valve (TV) pulsed Doppler velocities and derived gradients are commonly evaluated, data on normal pediatric values are limited. Conclusions: We report normal values and patterns of normality and physiological variability for MV and TV inflow Doppler from a large population of healthy children

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