Echocardiographic Reference Values for Right Atrial Size in Children with and without Atrial Septal Defects or Pulmonary Hypertension

Abstract

Right atrial (RA) size may become a very useful, easily obtainable, echocardiographic variable in patients with congenital heart disease (CHD) with right-heart dysfunction; however, according studies in children are lacking. We investigated growth-related changes of RA dimensions in healthy children. Moreover, we determined the predictive value of RA variables in both children with secundum atrial septal defect (ASD) and children with pulmonary hypertension (PH) secondary to CHD (PH-CHD). This is a prospective study in 516 healthy children, in 80 children with a secundum ASD (>7 mm superior-inferior dimension), and in 42 children with PH-CHD. We determined three RA variables, i.e., end-systolic major-axis length, end-systolic minor-axis length, and end-systolic area, stratified by age, body weight, length, and surface area. RA end-systolic length and area z scores were increased in children with ASD and PH-CHD when compared to those variables in the healthy control population. Using the Youden Index to determine the best cutoff scores in sex- and age-specific RA dimensions, we observed a sensitivity and specificity up to 94 and 91 %, respectively, in ASD children and 98 and 94 %, respectively, in PH-CHD children. We provide normal values (z scores -2 to +2) for RA size and area in a representative, large pediatric cohort. Enlarged RA variables with scores >+2 were predictive of secundum ASD and PH-CHD. Two-dimensional determination of RA size can identify enlarged RAs in the setting of high volume load (ASD) or pressure load (PH-CHD).

Pulmonary hypertension in bronchopulmonary dysplasia

“…12 Echocardiography for diagnosis and monitoring of PH TTE is an important diagnostic and monitoring modality. 12,[24][25][26][27] Screening for PH by TTE is indicated (1) if severe respiratory compromise is present in any preterm infant <28 weeks of gestation, (2) in any infant with established BPD at corrected age of 36 weeks gestation (p.m.) and before discharge, (3) in any infant with prolonged oxygen requirement, poor growth, unsatisfactory clinical improvement, 12 and has also been suggested at 7 days of life to identify infants at risk for BPD-PH. 4 Comprehensive TTE allows for complete initial assessment of cardiovascular anatomy and may also confirm RV pressure elevation through the measurement of the maximal velocity of the tricuspid regurgitation (TR) jet by continuous wave Doppler; TTE can detect impaired RV systolic function through qualitative assessment in several views, and quantitatively by means of a reduced age-related tricuspid annular plane systolic excursion as surrogate of longitudinal systolic RV function.…”

Atrial Septal Defects Accelerate Pulmonary Hypertension Diagnoses in Premature Infants

“…Retrospective studies of infants born before 32 weeks' gestation have demonstrated that a higher proportion of infants with PH have ASD, than infants without PH ( 23 ). Although small left-to-right shunts will often close spontaneously after birth, larger and persistent ASDs may ultimately require interventional closure or surgery ( 24 , 25 ). Small studies that have evaluated percutaneous transcatheter device closure of ASD in sick neonates have shown some improvements in respiratory status and medication use post-procedure, suggesting that, in some patients, treatment may improve outcomes ( 17 , 18 , 26 ).…”

Right Ventricular Outflow Tract (RVOT) Changes in Children with an Atrial Septal Defect: Focus on RVOT Velocity Time Integral, RVOT Diameter, and RVOT Systolic Excursion

“…We want to emphasize that also the RV and the RA have to be thoroughly investigated in all ASD patients. The RV and RA were not investigated in this current study because these data have recently been published . For the RVOT variables VTI, diameter, and SE reference data of echocardiographic normal children have recently been published, but no investigation of an enlarged RVOT size and flow in ASD children is available.…”