Relation of Mean Right Atrial Pressure to Doppler Parameters of Right
Atrial and Hepatic Venous Flow in Pediatric Patients with Congenital
Heart Disease
Objective: 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. Methods: 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 ≥8 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. Findings:
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).
Conclusion: This study showed that hepatic venous flow can be valuable
for estimation of mean RAP in pediatric patients with congenital heart
disease
