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Echocardiographic Evaluation of Pulmonary Arterial Hypertension in Pediatric Congenital Heart disease.

Journal of the Korean Pediatric Society 1984;27(10):971-981.
Published online October 31, 1984.
Echocardiographic Evaluation of Pulmonary Arterial Hypertension in Pediatric Congenital Heart disease.
Myoung Sung Moon, In Hee Park, Heung Jae Lee, Hahng Lee, Keun Soo Lee
Department of Pediatrics, Hanyang University College of Medicine, Seoul, Korea
선천성 심질환 환아에서의 폐동맥압상승에 따른 심초음파 소견에 관한 연구
문명성, 박인희, 이흥재, 이 항, 이근수
한양대학교 의과대학 소아과학교실
Abstract
To assess the validity of Echocardiographic criteria for pulmonary arterial hypertension we studied pulmonary valve motion in 75 congenital heart disease children. 75 patients were divided into two groups, A and B. The group A consisted of 39 patients who had normal pulmonary arterial pressure, group B consisted of 36 patients who had pulmonary arterial hypertension(pulmmonary artery mean pressure more than 20 mmHg, range 22~99). The results were as follows. 1)Maximal a wave excursion (Amax) was less than 2 mm in 28 of 36 patients in group B and was more than 2 mm in 36 of 39 patients in group A (78% sensitivity, 92% specificity and 85% accuracy). In 9 of 36 patients with, pulmonary hypertension showed absence of A wave. 2)e-f slope was less than 20 mm/sec in 16 of 36 patients in group B, and was more than 20 mm/sec in 36 of 39 patients in group A (44% sensitivity, 92% specificity and 69% accuracy). 3) b-c slope was more than 250mm/sec in 30 of 35 patients in group B, and was less than 250 mm/sec in 36 of 39 patients in group A. (83% sensitivity, 92% specificity and 88% accuracy) . 4)Right ventricular pre-ejection period (RPEP) was more than 0.95 sec in 22 of 36 patients in group B, and was less than 0.095 sec in 38 of 39 patients in group A (61% sensitivity, 97% specificity and 80%accuracy). 5)A midsystolic notching or fluttering occured in 23 of 36 patients in group B and of 39 patients in group A (64% sensitivity, 92% specificity and 79% accuracy). 6) Of the 36 congenital heart disease patients with pulmonary arterial hypertension, 28 fulfilled three or more echocardiographic criteria, while none of 39 pulmonary normotensive patients met three or more above echocardiographic criteria. Our experience shows changes in pulmonary valve Amax, e-f slope, b-c slope, RPEP and midsystolic notching are highly specific for pulmonary hypertension, but with varing sensitivity. We conclude that above mentioned echocardiographic criteria are useful in detecting pulmonary hypertension in pediatric congenital heart disease patient, but still may not be accurate enough for quantitative estimation of pulmonary artery pressure.
Key Words: Pulmonary arterial hypertension, Congenital heart disease, Echocardiography


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