Echocardiographic Evaluation of Ventricular Function—For the Neonatologist and Pediatric Intensivist

Abstract

In the neonatal and pediatric intensive care setting, bedside cardiac ultrasound is often used to assess ventricular dimensions and function. Depending upon the underlying disease process, it is necessary to be able to evaluate the systolic and diastolic function of left and or right ventricles. The systolic function of left ventricle is mostly assessed qualitatively on visual inspection “eye-balling” and quantitatively by measuring circumferential fraction shortening or calculating the ejection fraction by Simpson’s planimetry. The assessment of left ventricular diastolic function relies essentially on the mitral valve and pulmonary venous Doppler tracings or tissue Doppler evaluation. The right ventricular particular shape and anatomical position does not permit to use the same parameters for measuring systolic function as is used for the LV. Tricuspid annular plane systolic excursion (TAPSE) and S′ velocity on tissue Doppler imaging are more often used for quantitative assessment of right ventricle systolic function. Several parameters proposed to assess right ventricle systolic function such as fractional area change, 3D echocardiography, speckle tracking, and strain rate are being researched and normal values for children are being established. Diastolic function of right ventricle is evaluated by tricuspid valve and hepatic venous Doppler tracings or on tissue Doppler evaluation. The normal values for children are pretty similar to adults while normal values for the neonates, especially preterm infants, may differ significantly from adult population. The normal values for most of the parameters used to assess cardiac function in term neonates and children have now been established.

Point-of-care ultrasound use in pediatric intensive care units in Turkey

“…19,20 The echocardiography type referred to as critical-care echocardiography has become a part of the routine evaluation of patients in the PICU by pediatric intensivists. 20,21 This noninvasive technique allows the intensivist to measure ejection fraction, cardiac output and cardiac index and to assess pericardial effusion and becomes a guide for the management of treatment and ensuring the hemodynamic stability of critically ill patients. 21 The importance of cardiac index in guiding fluid and inotropic management in septic shock was emphasized in the recent clinical practice parameters published in 2017, which highlighted the significance of cardiac index measurement in the PICU.…”

“…20,21 This noninvasive technique allows the intensivist to measure ejection fraction, cardiac output and cardiac index and to assess pericardial effusion and becomes a guide for the management of treatment and ensuring the hemodynamic stability of critically ill patients. 21 The importance of cardiac index in guiding fluid and inotropic management in septic shock was emphasized in the recent clinical practice parameters published in 2017, which highlighted the significance of cardiac index measurement in the PICU. 22 In another survey similar to our study, the results showed a 72.7% rate of POCUS use for the assessment of cardiac function.…”

Comparison of cardiac output and cardiac index values measured by critical care echocardiography with the values measured by pulse index continuous cardiac output (PiCCO) in the pediatric intensive care unit:a preliminary study

“…Echocardiography is becoming a standard of care in many intensive care units and more clinicians are learning how to perform bedside critical care echocardiography technique as more pediatric intensivist are becoming familiar with bedside ultrasonography in the PICU. The echocardiography type referred to as criticalcare echocardiography has become a part of the routine evaluation of patients in the PICU by the pediatric intensivist [8]. This noninvasive technique allows the intensivist to measure and remeasure both CO and CI to guide patient management and ensure maintain hemodynamic stability to a critically ill patient.…”

Left ventricular ejection fraction using manual and semi‐automated biplane method of discs in very preterm infants

“…Cardiac ultrasound, in combination with clinical examination, is more sensitive for detection of cardiovascular compromise compared with clinical examination alone 3,4 . Ejection fraction (EF) is recommended as one of the echocardiographic parameters for detection of left ventricular (LV) systolic dysfunction in neonates 5,6 . LVEF is the fractional difference between left ventricular end‐diastolic volume (LV EDV) and end‐systolic volume (LV ESV) during one cardiac cycle and represents the efficiency of LV pump in handling LV preload and afterload through a dynamic interaction between the ventricle and the arterial system.…”