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

Abstract

In our study population, we show the RVOT VTI and diameter to be relevant predictors in identifying an enlarged RVOT size and flow in children with moderate to large ASD.

International evidence-based guidelines on Point of Care Ultrasound (POCUS) for critically ill neonates and children issued by the POCUS Working Group of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC)

“…POCUS can be used to assess cardiac function semi-quantitatively by assessing ejection fraction (EF) and fraction shortening (FS) [14,15]. In experienced hands, POCUS can be used for further assessment of left and right ventricular function as summarised in Table 2 [14,15,[32][33][34][35][36][37][38][39][40][41][42][43][44][45]. However, a detailed assessment of cardiac function should be performed by a neonatologist/paediatric intensivist with advanced echocardiography training or a paediatric cardiologist.…”

“…In experienced hands, it may be used for hemodynamic evaluation of the ductus arteriosus [8,10]. Semi-quantitative systolic ventricular function measures that may be used in POCUS have been summarised in Table 2 [32][33][34][35][36][37][38][39][40][41][42][43][44][45].…”

“…Semi-quantitative systolic ventricular function measures that might be used by the clinician with more evolved training in cardiac POCUS. Normative values are taken from the available literature on the topic[32][33][34][35][36][37][38][39][40][41][42][43][44][45] and represent the best reference data available so far, although, in some cases, specific level for a different class of patients' age are lacking…”

The right ventricular outflow tract in pediatric pulmonary hypertension—Data from the European Pediatric Pulmonary Vascular Disease Network

“…10 In children with an ASD, the RVOT VTI and RVOT diameter, but not the RVOT SE, have been shown to be significant predictors in estimating the ASD disease severity. 31 RV dimension and RVOT VTI were shown to be significant predictors of mortality in adult PH patients. Accordingly, prostacyclin treatment facilitated improvements of the RVOT VTI in these adult patients.…”

“…RVOT flow velocity determination is an essential part of the noninvasive investigation of pulmonary blood flow in adult patients . In children with an ASD, the RVOT VTI and RVOT diameter, but not the RVOT SE, have been shown to be significant predictors in estimating the ASD disease severity . RV dimension and RVOT VTI were shown to be significant predictors of mortality in adult PH patients.…”