Dynamic Systolic Changes in Tricuspid Regurgitation Vena Contracta Size and Proximal Isovelocity Surface Area in Hypoplastic Left Heart Syndrome: A Three-Dimensional Color Doppler Echocardiographic Study

Ling Li; Timothy M Colen; Vivek Jani; Benjamin T Barnes; Mary Craft; Edythe Tham; Nee Scze Khoo; Jeffrey Smallhorn; David A Danford; Shelby Kutty

doi:10.1016/j.echo.2021.03.004

Dynamic Systolic Changes in Tricuspid Regurgitation Vena Contracta Size and Proximal Isovelocity Surface Area in Hypoplastic Left Heart Syndrome: A Three-Dimensional Color Doppler Echocardiographic Study

J Am Soc Echocardiogr. 2021 Aug;34(8):877-886. doi: 10.1016/j.echo.2021.03.004. Epub 2021 Mar 19.

Authors

Affiliations

¹ Department of Pediatric Cardiology, University of Nebraska College of Medicine and Children's Hospital and Medical Center, Omaha, Nebraska.
² Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada.
³ Blalock-Taussig-Thomas Heart Center, Department of Pediatrics, Johns Hopkins Hospital, Baltimore, Maryland.
⁴ Blalock-Taussig-Thomas Heart Center, Department of Pediatrics, Johns Hopkins Hospital, Baltimore, Maryland. Electronic address: skutty1@jhmi.edu.

PMID: 33753189
DOI: 10.1016/j.echo.2021.03.004

Abstract

Background: The aims of this study were to investigate the dynamic changes in the vena contracta (VC) and proximal isovelocity surface area (PISA) through systole in patients with hypoplastic left heart syndrome and tricuspid regurgitation and to identify the stage of systole (early, mid, or late) in which VC and PISA radius are optimal.

Methods: Twenty-eight patients with hypoplastic left heart syndrome were prospectively studied using continuous two-dimensional (2D) and three-dimensional (3D) echocardiography. Two-dimensional VC width, 3D VC area, and PISA radii (2D and 3D) were measured frame by frame throughout systole. The maximal 2D VC width, 3D VC area, and PISA radii in the first, middle, and last thirds of systole were compared, and correlations were explored with 3D tricuspid annular areas, right atrial volumes, and right ventricular volumes.

Results: In all, 35 data sets that met inclusion criteria were analyzed. On frame-by-frame analysis, maximal 2D VC width and 3D VC area were found in the first third of systole in 17% and 20% of studies, in the second third in 34% and 31%, and in the final third in 49% and 49%. Similarly, the maximal 2D and 3D PISA radii were found in the first third of systole in 26% and 17% of studies, in the second third in 28% and 34%, and in the final third in 46% and 49%.

Conclusions: In hypoplastic left heart syndrome, detailed temporal analysis of tricuspid regurgitation-associated VC and PISA by 2D and 3D echocardiography reveals no reliable pattern predicting when in systole these parameters peak. Frame-by-frame measurement is necessary for identification of maximal VC and PISA radius on 2D and 3D color Doppler echocardiography because the severity of tricuspid regurgitation could be underestimated because of temporal variability in VC and PISA.

Keywords: Dynamic change; Effective regurgitant orifice area; Three-dimensional color Doppler echocardiography; Tricuspid regurgitation; Vena contracta area.

MeSH terms

Echocardiography, Doppler, Color
Echocardiography, Three-Dimensional*
Humans
Hypoplastic Left Heart Syndrome* / diagnostic imaging
Mitral Valve Insufficiency*
Reproducibility of Results
Severity of Illness Index
Systole
Tricuspid Valve Insufficiency* / diagnostic imaging