Echocardiographic assessment of pediatric semilunar valve disease

Abstract

We reviewed echocardiography literature for the assessment and management of semilunar valve disease in children. A search was performed within the National Library of Medicine using the keywords aortic stenosis (AS), aortic regurgitation, pulmonary stenosis (PS), and pulmonary regurgitation in children. The search was further refined adding the keywords-pediatric, neonates, echocardiographic definition, classification, evaluation. Thirty-eight studies were included. For stenotic lesions, there were sufficient consistencies between Doppler and invasive gradients (especially for PS), while other quantitative parameters used in adults showed significant limitations when applied to children. Heterogeneities remain in the range of Doppler measurements utilized to define mild vs moderate vs severe AS/PS, and to guide management. There is sufficient consensus regarding indications for interventions. In regurgitant lesions, there is weak evidence supporting the use of quantitative or semiquantitative parameters after correction for body surface area; clear indications for intervention are lacking. Because adult echocardiographic recommendations cannot be simply translated to the pediatric age, more specific pediatric guidelines and standards for the assessment of semilunar valve disease are needed.

Long-Term Postnatal Follow-Up in Monochorionic TTTS Twin Pregnancies Treated with Fetoscopic Laser Surgery and Complicated by Right Ventricular Outflow Tract Anomalies

“…Postnatal examinations of patients delivered in our hospital were carried out by a dedicated pediatric cardiologist. The right outflow tract was evaluated and the transpulmonary mean and maximum gradients were recorded to assess the presence and severity of the abnormality [11]. The postnatal criterion for the presence of PS was an echocardiographic ventricular to pulmonary artery pressure gradient of >20 mmHg.…”

Perfusion index in newborns with CHD without clinical signs of hypoperfusion and heart failure: comparison with healthy newborns

“…Pulmonary stenosis was classified according to peak Doppler gradient and graded as “mild” when it was < 25 mm Hg, “moderate” when it was 25–40 mm Hg and “severe” when it was > 50 mm Hg. 11…”

Congenital anatomy, acquired pathology – A synergistic approach to echocardiographic evaluation of the adult with congenital heart disease

“…In the pediatric age group, the large variation in body and heart size adds an additional challenge. Because of these differences in pathology, adult valve quantification methods cannot simply be applied to a pediatric age group 7 …”

“…Because of these differences in pathology, adult valve quantification methods cannot simply be applied to a pediatric age group. 7 The guideline for performance of a pediatric echocardiogram specifies that the approach is designed for the "wide spectrum of anomalies encountered in patients with congenital heart disease". 8 Echocardiographic views which would be unconventional in an adult laboratory, as well as probe "sweeps" take on added importance in this setting.…”