Appropriate Use Criteria for Pediatric Transthoracic Echo

J Am Coll Cardiol. 2014 Nov 11;64(19):2039-60. doi: 10.1016/j.jacc.2014.08.003. Epub 2014 Sep 29.

ACC/AAP/AHA/ASE/HRS/SCAI/SCCT/SCMR/SOPE 2014 

Appropriate Use Criteria for Initial Transthoracic Echocardiography in Outpatient Pediatric Cardiology

Campbell RM, Douglas PS, Eidem BW, Lai WW, Lopez L, Sachdeva R.

Also, Pediatrics 2014;134:e1774

Pediatric Dilated Cardiomyopathy - Recovery

Recovery of echocardiographic function in children with idiopathic cardiomyopathy. Results from Pediatric Cardiomyopathy Registry.

Melanie D. Everitt, et al. JACC 2014; 63(14): 1405-13.

Editorial: Alan Lewis. JACC 2014; 63(14): 1414-15.

Realtime 3D in Congenital Heart Disease

Echocardiography 2012;29:232-41

Real time three-dimensional echocardiography (RT3DE) has been increasingly used in the diagnosis and assessment of congenital heart disease. A growing body of literature suggests that this new technology can be used as an integrated approach to assess the morphology of simple and complex congenital heart defects, flow abnormality, and left, right, and single ventricular function both qualitatively and quantitatively. This review summarizes the available evidence for the use of RT3DE in each of these areas. Future technology refinement in RT3DE and development of practice guidelines will increase the utilization of this new technology as a valuable tool to compliment 2D echocardiography/Doppler in clinical care and research to improve the care and outcome of congenital heart disease. (Echocardiography 2012;29:232-241)

Echo, Fetal echo: Predicting need for balloon atrial septostomy in d-TGA

J Am Soc Echocardiogr. 2011 Apr;24(4):425-30. Epub 2011 Feb 15.

Fetal predictors of urgent balloon atrial septostomy in neonates with complete transposition.

Punn R, Silverman NH.

Source

Stanford University, Lucile Packard Children's Hospital, Palo Alto, California, USA.

Abstract

BACKGROUND:

In complete transposition of the great vessels, a restrictive patent foramen ovale leads to inadequate circulatory mixing and severe cyanosis. Urgent balloon atrialseptostomy (BAS) improves mixing and bridges neonates to surgery. Several studies have determined risk factors in utero for poor postnatal outcomes in complete transposition of the great vessels, particularly a restrictive patent foramen ovale and ductus arteriosus. In addition to these risk factors, we studied two new features, a hypermobile septum and reverse diastolic patent ductus arteriosus shunt, to determine which patients will require an urgent BAS.

METHODS:

We reviewed all 26 fetuses from 2001 to 2010 with complete transposition of the great vessels and closely examined the patent foramen ovale and septum primum for hypermobility, restriction, flat appearance, or redundancy. We defined hypermobility as a septum primum flap that oscillates between both atria. We also examined the ductus size and shunting pattern to evaluate whether these features contributed to urgent BAS.

RESULTS:

In total, 14 of 26 fetuses required urgent BAS with improved cyanosis. Nine fetuses had an urgent BAS and a hypermobile septum, and 12 fetuses had no urgent BAS or hypermobile septum. Eight fetuses had an urgent BAS and a reverse diastolic patent ductus arteriosus, and 11 fetuses had no urgent BAS or reverse diastolic patent ductus arteriosus. A hypermobile septum and reverse diastolic patent ductus arteriosus had a significant association with urgent BAS (P < .01, sensitivity = 0.64 and 0.57, specificity = 1.0 and 0.92, positive predictive value = 1.0 and 0.89, negative predictive value = 0.71 and 0.65). No fetus had a restrictive patent foramen ovale/ductus arteriosus.

CONCLUSION:

A hypermobile septum and reverse diastolic patent ductus arteriosus are new prenatal findings to help predict the need for an urgent BAS postnatally in patients with complete transposition of the great vessels.

Adult: Echo evaluation of hemodynamics in heart failure

CIRCIMAGING.111.963496Published online before print March 11, 2011

Echocardiographic Evaluation of Hemodynamics in Patients with Decompensated Systolic Heart Failure

1. Sherif Nagueh1*,
2. Rajat Bhatt1,
3. Ray P. Vivo1,
4. Selim R. Krim1,
5. Sebastian Imre Sarvari2,
6. Kristoffer Russell2,
7. Thor Edvardsen2,
8. Otto A. Smiseth2 and
9. Jerry D. Estep

Abstract

Background—Doppler echocardiography is currently applied for the assessment of left ventricular (LV) and right ventricular (RV) hemodynamics in patients with cardiovascular disease. However, there are conflicting reports about its accuracy in patients with unstable decompensated heart failure. The objective of this study was to evaluate the accuracy of the technique in patients with unstable heart failure.

Methods and Results—Consecutive patients with decompensated heart failure had simultaneous assessment of LV and RV hemodynamics invasively and by Doppler echocardiography. In 79 patients, the non-invasive measurements of stroke volume (r=0.83, p<0.001), r="0.83," r="0.51," p="0.009)," r="0.85,">15 mmHg (AUC from 0.86 to 0.92). The recent ASE/EAE guidelines were highly accurate (sensitivity : 98%, specificity : 91%) in identifying patients with increased wedge pressure. In 12 repeat studies, Doppler echocardiography readily detected the changes in mean wedge pressure (r=0.75, p=0.005) as well as changes in pulmonary artery systolic pressure and mean right atrial pressure.

Conclusions—Doppler echocardiography provides reliable assessment of LV hemodynamics in patients with decompensated heart failure.

Copyright © 2011, American Heart Association, Inc. All rights reserved. Unauthorized use prohibited

Echo: Hypoplastic Left Heart Syndrome - RV function

J Am Coll Cardiol Img, 2011; 4:128-137
© 2011 by the American College of Cardiology Foundation

Novel Insights Into RV Adaptation and Function in Hypoplastic Left Heart Syndrome Between the First 2 Stages of Surgical Palliation
Nee Scze Khoo, MBChB*,*, Jeffrey F. Smallhorn, MD*, Sachie Kaneko, MD*, Kimberly Myers, MD*, Shelby Kutty, MD, Edythe B. Tham, MBBS*

Objectives: This study sought to examine the changes in ventricular function of hypoplastic left heart syndrome (HLHS) between the first 2 stages of surgical palliation.

Background: The mortality risk between first and second stages of surgical palliation in HLHS remains high. Right ventricular (RV) dysfunction predicts mortality. Postulated mechanisms include a maladaptive contraction pattern, myocardial ischemia, or contraction asynchrony. Speckle tracking imaging allows accurate measurement of myocardial deformation without geometric assumptions.

Methods: Prospective echocardiography pre-Norwood and pre-bidirectional cavopulmonary anastomosis (BCPA) examinations were performed in 20 HLHS patients, with comparisons made between stages. Measurements of ventricular function included: longitudinal/circumferential strain ratio, reflecting changes in contraction pattern; post-systolic strain index, a potential marker of myocardial ischemia; and mechanical dyssynchrony index. Relationships between echocardiographic variables and magnetic resonance imaging RV parameters before BCPA were examined.

Results: Before BCPA, myocardial contractility estimated by isovolumic acceleration and strain rate was reduced, paralleled by an increased in post-systolic strain index (p < 0.01). Right ventricular longitudinal/circumferential strain ratio decreased, becoming similar to a left ventricle–like contraction pattern, and this correlated with decreased mechanical dyssynchrony index (r = 0.65, p < 0.01), magnetic resonance imaging RV end-diastolic volume (r = 0.65, p < 0.05) and mass (r = 0.71, p < 0.01). Ventricular strain (r = –0.72, p < 0.01), strain rate (r = –0.85, p < 0.001), and mechanical dyssynchrony index (r = –0.73, p < 0.01) correlated linearly with magnetic resonance imaging–derived RV ejection fraction.

Conclusions: Reduced RV contractility occurred before BCPA. RV with a left ventricle–like contraction pattern was associated with improved contraction synchrony as well as a reduction in RV size and mass in HLHS. The finding of increased post-systolic strain index before BCPA is novel and its potential link with myocardial ischemia warrants further investigation. RV strain, strain rate, and contraction synchrony measured by speckle tracking imaging correlated closely with ventricular function and might be useful for monitoring ventricular function in HLHS.

LV remodeling - Imaging (Review)

Marvin Konstam et al. JACC Img. 2011;4:98-108

3D-TEE evaluation of mitral valve

JACC Img 2011;4:94-97

Echo: 3D imaging of ASD & Right Atrium

Anatomy of Right Atrial Structures by Real-Time 3D Transesophageal Echocardiography
Francesco F. Faletra, Siew Y. Ho, and Angelo Auricchio
J Am Coll Cardiol Img 2010;3 966-975

3D Echocardiography of the Atrial Septum: Anatomical Features and Landmarks for the Echocardiographer
Kuberan Pushparajah, Owen I. Miller, and John M. Simpson
J Am Coll Cardiol Img 2010;3 981-984

Umbalanced AV septal defect: Surgical decision making based on echo

Circulation. 2010;122:S209-S215

Echocardiographic Definition and Surgical Decision-Making in Unbalanced Atrioventricular Septal Defect
A Congenital Heart Surgeons’ Society Multiinstitutional Study

Anusha Jegatheeswaran, MD; Christian Pizarro, MD; Christopher A. Caldarone, MD; Meryl S. Cohen, MD; Jeanne M. Baffa, MD; David B. Gremmels, MD; Luc Mertens, MD, PhD; Victor O. Morell, MD; William G. Williams, MD; Eugene H. Blackstone, MD; Brian W. McCrindle, MD, MPH; David M. Overman, MD

Background—Although identification of unbalanced atrioventricular septal defect (AVSD) is obvious when extreme, exact criteria to define the limits of unbalanced are not available. We sought to validate an atrioventricular valve index (AVVI) (left atrioventricular valve area/total atrioventricular valve area, centimeters squared) as a discriminator of balanced and unbalanced forms of complete AVSD and to characterize the association of AVVI with surgical strategies and outcomes.

Methods and Results—Diagnostic echocardiograms and hospital records of 356 infants with complete AVSD at 4 Congenital Heart Surgeons’ Society (CHSS) institutions (2000–2006) were reviewed and AVVI measured (n=315). Patients were classified as unbalanced if AVVI0.4 (right dominant) or 0.6 (left dominant). Surgical strategy and outcomes were examined across the range of AVVI. Competing risks analysis until the time of commitment to a surgical strategy examined 4 end states: biventricular repair (BVR), univentricular repair (UVR), pulmonary artery banding (PAB), and death before surgery. A prediction nomogram for surgical strategy based on AVVI was developed.
The majority of patients had balanced AVSD (avvi between 0.4 and 0.6)
Conclusions—AVVI effectively characterizes the transition between balanced and unbalanced AVSD with important correlation to anatomic substrate and selected surgical strategy.

Quatitation of Aortic Regurgitation using echocardiography

Circulation: Cardiovascular Imaging. 2010;3:542-549

An Echocardiographic Model Predicting Severity of Aortic Regurgitation in Congenital Heart Disease

Rebecca S. Beroukhim, MD; Dionne A. Graham, PhD; Renee Margossian, MD; David W. Brown, MD; Tal Geva, MD and Steven D. Colan, MD

Background—Multiple echocardiographic parameters have been identified to predict the severity of aortic regurgitation (AR) with variable reliability. This study was performed to identify which echocardiographic parameters best predict the severity of AR in a cohort of patients with congenital heart disease, using cardiovascular MRI quantification as a reference standard.

Methods and Results—The study involved 2 phases. In phase 1, predictive models were developed on the basis of multivariable analysis of various morphometric and Doppler variables obtained from 174 echocardiograms that best predicted the severity of AR as defined by paired cardiovascular MRI examinations. A nonlinear estimate of regurgitation fraction, using the variables parasternal vena contracta-derived area divided by body surface area and abdominal aorta Doppler retrograde velocity-time integral divided by antegrade velocity-time integral, was identified through multivariable analysis as the best predictive model for AR fraction. In phase 2, the predictive models were prospectively tested on 43 echocardiographic examinations for which a paired cardiovascular MRI was performed. The agreement between the observed and predicted AR fraction was assessed using Bland-Altman analysis. For the 30 studies of the validation data set that had adequate quality images of both the parasternal vena contracta width and the abdominal aorta flow profile, the predicted AR values had a mean bias±SD of 0.4±7.3% (P=0.80).

Conclusions—A model using the 2 variables parasternal vena contracta-derived area divided by body surface area and abdominal aorta Doppler retrograde velocity-time integral divided by antegrade velocity-time integral can predict AR severity in patients with a wide variety of congenital heart disease.