Estimation of right atrial pressure from the inspiratory collapse of the inferior vena cava in pediatric patients

Paucity of data exists between mean right atrial pressure [RAP] and inferior vena cava [IVC] size and collapsibility in pediatric patients with congenital heart disease. In a prospective study, fifty consecutive pediatric patients with different congenital heart diseases who had right side cardiac catheterization were studied, comparing right atrial pressure with simultaneous M-mode echocardiographic measurement of inferior vena cava diameter. Mean age of the patients was 4.96 +/- 4.05 years [30 male and 20 female]. Patients were categorized into two groups according to their right atrial pressure [RAP] as measured by cardiac catheterization: Group 1 [40 patients] were those with mean RAP <8 mmHg and group 2 [10 patients] who had a mean RAP> 8 mmHg. In M-mode echocardiography IVC size was statistically different [P=0.004 and 0.009] in inspiration and expiration in the two groups. Mean RAP was estimated to be > 8 mmHg when IVC diameter in inspiration was >3.6 [sensitivity of 100%, specificity of 47.5%, +LR=1.9] or if IVC diameter was >6mm in expiration [sensitivity of 70%, specificity of 87%, +LR=4.67]. This study showed that measurement of IVC size in inspiration and expiration can be used as a reliable method for estimation of mean right atrial pressure

Relation of mean right atrial pressure to doppler parameters of right atrial and hepatic venous flow in pediatric patients with congenital heart disease

A paucity of data exists regarding the relation of mean right atrial pressure [RAP] to Doppler parameters of right atrial and ventricular filling in pediatric patients with congenital heart disease. Fifty patients [30 male and 20 female] with mean age of 4.96 +/- 4.05 who were admitted in the pediatric cardiology ward of Nemazee Hospital affiliated to Shiraz University of Medical Sciences, were included in this study. Patients were categorized into two groups according to their RAP measured by cardiac catheterization: Group 1 [40 patients] were those with mean RAP <8 mmHg and group 2 [10 patients] who had mean RAP 38 mmHg. Data gathered from hepatic venous flow, tricuspid diastolic flow and pulse tissue Doppler of lateral tricuspid annulus of each patient were then compared with right atrial pressure obtained by cardiac catheterization. If change of peak S wave velocity of hepatic vein in respiration was more than 38%, sensitivity and specificity of a RAP more than 8 mmHg was 90% and 51.3% respectively with likelihood ratio [LR] equal to 1.85; a peak S wave velocity of less than 70 mm/sec also showed a RAP more than 8 mmHg with sensitivity and specificity of 70 and 82.1 respectively [LR=3.9]. A peak expiratory D wave velocity of hepatic vein more than 63 mm/sec was indicator of RAP more than 8 mmHg with sensitivity and specificity of 60% and 92.3% respectively [LR=7.8]. This study showed that hepatic venous flow can be valuable for estimation of mean RAP in pediatric patients with congenital heart disease