Comparison of transthoracic echocardiography and right heart catheterization for assessing pulmonary arterial pressure in patients with congenital or valvular heart defects

Although right heart catheterization [RHC] has acceptable accuracy for the measurement of pulmonary arterial pressure [PAP], significant risks and cost issues are worrisome. Thus, a non-invasive technique such as echocardiography for assessing PAP would clearly be of great clinical value. We aimed to compare estimated systolic PAP [SPAP] by echocardiogram with the actual RHC measurements in the two groups of congenital and valvular heart diseases [CHD and VHD, respectively], in whom pulmonary hypertension [PHT] was clinically suspected. A total of 103 consecutive patients with confirmed CHD or VHD referred to our center between January and December 2009 were studied. Participants underwent transthoracic echocardiogaphy and RHC within 4 hours of each other. The mean SPAP in the CHD group was no different measured by RHC or echo [46.49 +/- 29.04 vs. 46.45 +/- 23 mmHg, p = 0.541]. The mean SPAP in the VHD group measured by RHC was significantly higher than that measured by echo [48.70 +/- 14.50 vs. 44.90 +/- 11.0 mmHg, p = 0.041]. Fifty-one [49.5%] patients were found to have PHT at RHC. Echocardiography correctly identified 48 of these patients [sensitivity=94.1%]. Nineteen of the 52 patients without PHT on RHC were correctly identified by echocardiography [specificity= 36.5%]. The positive and negative predictive values for echocardiography in assessing the presence or absence of PHT were 59.3% and 86.4%, respectively. Integration of hemodynamic data with the eho examination can appropriately provide comprehensive assessment of PHT with high sensitivity in individual patients with congenital or valvular heart defects

[ causes of short stature among children in Gorgan-Iran]

Short stature among children is often due to physiological causes but it can be a sign of important and curable diseases. Thus early detection of problem, before epiphyseal closure, is critical. This study was done to determine the cause of short stature among children in Gorgan-Iran. This cross- sectional research study was done on 100 children of 6-14 years of age during 2005 in Gorgan-Iran. Children were selected by census. Demographic character of children, history of serious disease, prematurity, blood and provocative growth hormone tests, physical examination, wrist radiography and standard deviation score [SDS] were recorded for each child. Data were analyzed by t-student and chi-square tests. The finding of this study showd that most children with short stature was girl [66%]. mean+-SD of calendar and bone age of female children was 10.4+-2.25 and 8.4+-2.32 year, respectively. The most frequent causes of short stature were constitutional [57%], Growth hormone deficiency [30%] and familial causes [8%]. Mean+-SD of calendar and bone age of males children was 10.79+-2.32 and 7.89+-2.19 years. Children with growth hormone deficiency had lower bone age and children with constitutional short stature had higher standard deviation score than others. [P<0.05]. This study showed that since growth hormone deficiency was one of the common and important pathologic causes of short stature. Therefore growth hormone determination and theraphy is recommended, after elimination of familial and constitutional factors