Panidapu Nagarjuna, Babu Saravana, Dharan Baiju S, Sen Barsha, Koshy Thomas
Department of Cardiac Anaesthesia, Amrita Institute of Medical Sciences, Kochi, Kerala, India.
Department of Cardiothoracic and Vascular Anaesthesia, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.
Ann Card Anaesth. 2025 Jan 1;28(1):53-60. doi: 10.4103/aca.aca_85_24. Epub 2025 Jan 24.
This study aimed to assess the accuracy of tricuspid spectral Doppler (E/A) and tissue Doppler parameters (E/E') to diagnose right ventricular diastolic dysfunction (RVDD) in comparison to American Society of Echocardiography (ASE criteria) in pediatric tetralogy of Fallot (TOF) patients after surgical repair.
This prospective, observational study was done at a tertiary care hospital involving 40 pediatric TOF patients aged less than 2 years who underwent complete intracardiac repair with cardiopulmonary bypass (CPB). Echocardiographic observations were made using a pediatric transesophageal echocardiography probe after surgical repair in the post-CPB period. The ASE-described parameters (late diastolic forward flow in the main pulmonary artery, right atrial dilatation, inferior vena cava dilatation, and hepatic venous flow reversal) were acquired to diagnose the RVDD. The tricuspid Doppler parameters (E/A and E/E') were measured, and its predictive ability to diagnose RVDD was analyzed and compared with the ASE criteria.
Based on the ASE criteria, 13 patients (32.5%) were diagnosed to have RVDD. We found that an E/E' ratio of ≥ 6.26 and an E/A ratio of >1.34 can be taken as the cutoff for diagnosing the RVDD. Based on the tricuspid Doppler parameters (E/A > 1.34 and E/E' >6.26), 17 patients (42.5%) were diagnosed to have RVDD, which was comparable to that of the diagnosis by ASE criteria (P > 0.05).
The results suggested that the use of tricuspid Doppler parameters can be equally accurate and reproducible to the current ASE-described echocardiographic parameters for diagnosing RVDD after surgical repair of TOF.
本研究旨在评估与美国超声心动图学会（ASE标准）相比，三尖瓣频谱多普勒（E/A）和组织多普勒参数（E/E'）在法洛四联症（TOF）患儿手术修复后诊断右心室舒张功能障碍（RVDD）的准确性。
这项前瞻性观察性研究在一家三级医疗中心进行，纳入40例年龄小于2岁、接受体外循环（CPB）下完全心内修复术的小儿TOF患者。在CPB术后手术修复后，使用小儿经食管超声心动图探头进行超声心动图观察。获取ASE描述的参数（主肺动脉舒张末期正向血流、右心房扩张、下腔静脉扩张和肝静脉血流逆转）以诊断RVDD。测量三尖瓣多普勒参数（E/A和E/E'）并分析其诊断RVDD的预测能力，并与ASE标准进行比较。
根据ASE标准，13例患者（32.5%）被诊断为RVDD。我们发现E/E'比值≥6.26和E/A比值>1.34可作为诊断RVDD的临界值。根据三尖瓣多普勒参数（E/A>1.34和E/E'>6.26），17例患者（42.5%）被诊断为RVDD，这与ASE标准诊断结果相当（P>0.05）。
结果表明，对于TOF手术修复后诊断RVDD，使用三尖瓣多普勒参数与当前ASE描述的超声心动图参数同样准确且可重复。
