Pediatric diastology: use and limitations of Doppler echocardiography in the evaluation of ventricular diastolic function in children

Abstract

Diastole has often been the forgotten portion of the cardiac cycle, especially in pediatrics. Recent advances in the understanding of heart failure and its etiologies point out that the impact of diastolic dysfunction can no longer be ignored. Doppler echocardiography has provided many insights into diastole and disturbances of diastolic function in adults and children. Doppler techniques, their use and limitations in the non-invasive assessment of pediatric ventricular diastolic function are reviewed. A grading scheme is presented that allows a semi-quantitative classification of the degree of diastolic dysfunction present. Traditional analysis of isolated atrioventricular valve flow patterns does not provide adequate information regarding diastolic ventricular performance. Atrioventricular valve flow signals must be interpreted in conjunction with the flow patterns seen in the proximal venous system in order to provide a complete Doppler assessment of diastolic function.