Valvar regurgitation in normal children: Is it clinically significant?

Abstract

SummaryThis study aimed to assess the prevalence of “silent” valvar regurgitation in healthy Brazilian children; to determine whether variations in the gain settings of the machine interfered with its documentation; and to compare Doppler color flow mapping with the pulsed wave Doppler. Twenty-five healthy children were selected randomly. Echocardiographic equipment used was ALOKA 870. Fixed parameters were 3.5 MHz transducer, 400 Hz filter, reject of 7/14 and aperture of 30/80. Variable parameters were Doppler color flow mapping and pulsed wave Doppler gains. A protocol for evaluation of each cardiac valve was developed. Regurgitation was noted in 93% for the pulmonary valve, 74% for the tricuspid valve and 27% for the mitral valve. In the aortic valve, jets suggestive of mild valvar regurgitation were observed with the Doppler color flow mapping technique in two children but these findings were not corroborated by pulsed wave Doppler. Only in the aortic valve were findings from Doppler color flow mapping not in agreement with those from pulsed wave Doppler. Variations in the settings for gain did not interfere significantly in the documentation of regurgitation. Inter-observer variations were not significant (two independent operators). The clinical implications of these findings are yet to be established. Labeling these regurgitant jets as “normal” may be oversimplifying their meaning and perhaps overlooking the possibility of predisposition to endocarditis or progression of the valvar abnormality. Conversely, labeling them as “abnormal” can generate a more serious problem, which is that of iatrogenic heart disease. Prospective follow-up studies should be carried out in these subjects.

Prevalence of valvar regurgitation in Nigerian children with structurally normal hearts using colour doppler echocardiography

“…It was also noted that these single valvar regurgitations only involved the right sided valves which we also found to show more regurgitation than the left sided valves. Right valvar regurgitation predominance in normal hearts has similarly been described in previous studies although with variations in individual valvar regurgitation [3,6,[10][11][12]16]. The prevalence of pulmonary regurgitation (PR) noted in our study was slightly higher than that of the tricuspid regurgitation (TR) with prevalence of 52.8% and 45.9% respectively.…”

“…Some authors have suggested that the frequency of right-sided regurgitation may be related to the closer positioning of the transducer to the right side of the heart which reduces interferences and enhances image quality of Doppler signals [10]. The low prevalence of left sided valvar regurgitation in our study has also been reported by other authors [9,16,17]. Thompson, et al [9], reported a prevalence of <2% of MR among 32 children in their study and AR in only one child.…”