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Abstract

Echocardiography is a valuable tool used to aid in the management of pediatric patients in the ICU. Echocardiography allows for the assessment of cardiac physiology including cardiac function, pericardial effusions, suspicion for pulmonary hypertension, and cardiac valve integrity. The use of echocardiography for the assessment of mechanical cardiac support and suspected endocarditis is discussed. Echocardiography is particularly suited for the postoperative assessment after cardiac surgery and the unique physiology of single ventricle patients.

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References

  1. Ommen SR, Nishimura RA, Appleton CP et al (2000) Clinical utility of doppler echocardiography and tissue doppler imaging in the estimation of left ventricular filling pressures: a comparative simultaneous doppler-catheterization study. Circulation 102(15):1788–1794

    Article  CAS  PubMed  Google Scholar 

  2. Section on Cardiology and Cardiac, Surgery, American Academy of P. Guidelines for pediatric cardiovascular centers (2002) Pediatrics 109(3):544–549

    Google Scholar 

  3. Scohy TV, Gommers D, Jan ten Harkel AD, Deryck Y, McGhie J, Bogers AJ (2007) Intraoperative evaluation of micromultiplane transesophageal echocardiographic probe in surgery for congenital heart disease. Eur J Echocardiogr 8(4):241–246

    Article  PubMed  Google Scholar 

  4. Hilberath JN, Oakes DA, Shernan SK, Bulwer BE, D’Ambra MN, Eltzschig HK (2010) Safety of transesophageal echocardiography. J Am Soc Echocardiogr 23(11):1115–1127

    Article  PubMed  Google Scholar 

  5. Noritomi DT, Vieira ML, Mohovic T et al (2010) Echocardiography for hemodynamic evaluation in the intensive care unit. Shock 34(Suppl 1):59–62

    Article  PubMed  Google Scholar 

  6. Ihlen H, Amlie JP, Dale J et al (1984) Determination of cardiac output by doppler echocardiography. Br Heart J 51(1):54–60

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Chew MS, Poelaert J (2003) Accuracy and repeatability of pediatric cardiac output measurement using doppler: 20-year review of the literature. Intensive Care Med 29(11):1889–1894

    Article  PubMed  Google Scholar 

  8. Mason DT, Braunwald E, Covell JW, Sonnenblick EH, Ross J Jr (1971) Assessment of cardiac contractility. The relation between the rate of pressure rise and ventricular pressure during isovolumic systole. Circulation 44(1):47–58

    Article  CAS  PubMed  Google Scholar 

  9. Crepaz R, Pitscheider W, Radetti G, Gentili L (1998) Age-related variation in left ventricular myocardial contractile state expressed by the stress velocity relation. Pediatr Cardiol 19(6):463–467

    Article  CAS  PubMed  Google Scholar 

  10. Lopez L (2009) Advances in echocardiography. Curr Opin Pediatr 21(5):579–584

    Article  PubMed  Google Scholar 

  11. Jenkins C, Bricknell K, Hanekom L, Marwick TH (2004) Reproducibility and accuracy of echocardiographic measurements of left ventricular parameters using real-time three-dimensional echocardiography. J Am Coll Cardiol 44(4):878–886

    Article  PubMed  Google Scholar 

  12. Hoffmann R, von Bardeleben S, ten Cate F et al (2005) Assessment of systolic left ventricular function: a multi-centre comparison of cineventriculography, cardiac magnetic resonance imaging, unenhanced and contrast-enhanced echocardiography. Eur Heart J 26(6):607–616

    Article  PubMed  Google Scholar 

  13. Gudmundsson P, Rydberg E, Winter R, Willenheimer R (2005) Visually estimated left ventricular ejection fraction by echocardiography is closely correlated with formal quantitative methods. Int J Cardiol 101(2):209–212

    Article  PubMed  Google Scholar 

  14. Snider AR, Serwer GA, Ritter SB (1997) Echocardiography in pediatric heart disease. Mosby, St. Louis

    Google Scholar 

  15. Pai RG, Bansal RC, Shah PM (1990) Doppler-derived rate of left ventricular pressure rise. Its correlation with the postoperative left ventricular function in mitral regurgitation. Circulation 82(2): 514–520.

    CAS  PubMed  Google Scholar 

  16. Tousignant CP, Walsh F, Mazer CD (2000) The use of transesophageal echocardiography for preload assessment in critically ill patients. Anesth Analg 90(2):351–355

    CAS  PubMed  Google Scholar 

  17. Levitov A, Marik PE (2012) Echocardiographic assessment of preload responsiveness in critically ill patients. Cardiol Res Pract. doi:ID:819696

    Google Scholar 

  18. Lang RM, Borow KM, Neumann A, Janzen D (1986) Systemic vascular resistance: an unreliable index of left ventricular afterload. Circulation 74(5):1114–1123

    Article  CAS  PubMed  Google Scholar 

  19. Courand JA, Marshall J, Chang Y, King ME (2001) Clinical applications of wall-stress analysis in the pediatric intensive care unit. Crit Care Med 29(3):526–533

    Article  CAS  PubMed  Google Scholar 

  20. Peterson AL, Frommelt PC, Mussatto K (2006) Presentation and echocardiographic markers of neonatal hypertensive cardiomyopathy. Pediatrics 118(3):e782–e785

    Article  PubMed  Google Scholar 

  21. Pirracchio R, Cholley B, De Hert S, Solal AC, Mebazaa A (2007) Diastolic heart failure in anaesthesia and critical care. Br J Anaesth 98(6):707–721

    Article  CAS  PubMed  Google Scholar 

  22. Lester SJ, Tajik AJ, Nishimura RA, Oh JK, Khandheria BK, Seward JB (2008) Unlocking the mysteries of diastolic function: deciphering the rosetta stone 10 years later. J Am Coll Cardiol 51(7):679–689

    Article  PubMed  Google Scholar 

  23. Ichihashi K, Sato A, Shiraishi H, Momoi M (2011) Tissue doppler combined with pulsed-wave doppler echocardiography for evaluating ventricular diastolic function in normal children. Echocardiography 28(1):93–96

    Article  PubMed  Google Scholar 

  24. Redfield MM, Jacobsen SJ, Burnett JC Jr, Mahoney DW, Bailey KR, Rodeheffer RJ (2003) Burden of systolic and diastolic ventricular dysfunction in the community: appreciating the scope of the heart failure epidemic. JAMA 289(2):194–202

    Article  PubMed  Google Scholar 

  25. Cullen S, Shore D, Redington A (1995) Characterization of right ventricular diastolic performance after complete repair of tetralogy of Fallot. Restrictive physiology predicts slow postoperative recovery. Circulation 91(6):1782–1789

    Article  CAS  PubMed  Google Scholar 

  26. Plotnick GD, Rubin DC, Feliciano Z, Ziskind AA (1995) Pulmonary hypertension decreases the predictive accuracy of echocardiographic clues for cardiac tamponade. Chest 107(4):919–924

    Article  CAS  PubMed  Google Scholar 

  27. Price S, Nicol E, Gibson DG, Evans TW (2006) Echocardiography in the critically ill: current and potential roles. Intensive Care Med 32(1):48–59

    Article  CAS  PubMed  Google Scholar 

  28. Guntheroth WG (2007) Sensitivity and specificity of echocardiographic evidence of tamponade: implications for ventricular interdependence and pulsus paradoxus. Pediatr Cardiol 28(5):358–362

    Article  CAS  PubMed  Google Scholar 

  29. Pepi M, Muratori M, Barbier P et al (1994) Pericardial effusion after cardiac surgery: incidence, site, size, and haemodynamic consequences. Br Heart J 72(4):327–331

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. McLaughlin VV, Archer SL, Badesch DB, Barst RJ, Farber HW, Lindner JR, Mathier MA, McGoon MD, Park MH, Rosenson RS, Rubin LJ, Tapson VF, Varga J, American College of Cardiology Foundation Task Force on Expert Consensus Documents, American Heart Association, American College of Chest Physicians, American Thoracic Society, Inc. Pulmonary Hypertension Association (2009) ACCF/AHA 2009 expert consensus document on pulmonary hypertension a report of the American college of cardiology foundation task force on expert consensus documents and the American heart association developed in collaboration with the American college of chest physicians; American thoracic society, inc.; and the pulmonary hypertension association. J Am Coll Cardiol 53(17):1573–1619

    Article  PubMed  Google Scholar 

  31. Simonneau G, Robbins IM, Beghetti M et al (2009) Updated clinical classification of pulmonary hypertension. J Am Coll Cardiol 54(Suppl 1):S43–S54

    Article  PubMed  Google Scholar 

  32. del Cerro MJ, Abman S, Diaz G et al (2011) A consensus approach to the classification of pediatric pulmonary hypertensive vascular disease: report from the PVRI pediatric taskforce, panama 2011. Pulm Circ 1(2):286

    Article  PubMed  PubMed Central  Google Scholar 

  33. Janda S, Shahidi N, Gin K, Swiston J (2011) Diagnostic accuracy of echocardiography for pulmonary hypertension: a systematic review and meta-analysis. Heart 97(8):612–622

    Article  PubMed  Google Scholar 

  34. Rich JD, Shah SJ, Swamy RS, Kamp A, Rich S (2011) Inaccuracy of doppler echocardiographic estimates of pulmonary artery pressures in patients with pulmonary hypertension: implications for clinical practice. Chest 139(5):988–993

    Article  PubMed  Google Scholar 

  35. Milan A, Magnino C, Veglio F (2010) Echocardiographic indexes for the non-invasive evaluation of pulmonary hemodynamics. J Am Soc Echocardiogr 23(3):225–239

    Article  PubMed  Google Scholar 

  36. McQuillan BM, Picard MH, Leavitt M, Weyman AE (2001) Clinical correlates and reference intervals for pulmonary artery systolic pressure among echocardiographically normal subjects. Circulation 104(23):2797–2802

    Article  CAS  PubMed  Google Scholar 

  37. Mourani PM, Sontag MK, Younoszai A, Ivy DD, Abman SH (2008) Clinical utility of echocardiography for the diagnosis and management of pulmonary vascular disease in young children with chronic lung disease. Pediatrics 121(2):317–325

    Article  PubMed  PubMed Central  Google Scholar 

  38. Galie N, Hoeper MM, Humbert M, Torbicki A, Vachiery JL, Barbera JA, Beghetti M, Corris P, Gaine S, Gibbs JS, Gomez-Sanchez MA, Jondeau G, Klepetko W, Opitz C, Peacock A, Rubin L, Zellweger M, Simonneau G (2009) ESC Committee for Practice Guidelines. (CPG) Guidelines for the diagnosis and treatment of pulmonary hypertension: the task force for the diagnosis and treatment of pulmonary hypertension of the european society of cardiology (ESC) and the european respiratory society (ERS), endorsed by the international society of heart and lung transplantation (ISHLT). Eur Heart J 30(20):2493–2537

    Article  PubMed  Google Scholar 

  39. Nakahata Y, Hiraishi S, Oowada N et al (2009) Quantitative assessment of pulmonary vascular resistance and reactivity in children with pulmonary hypertension due to congenital heart disease using a noninvasive method: new doppler-derived indexes. Pediatr Cardiol 30(3):232–239

    Article  PubMed  Google Scholar 

  40. Vogel M, Weil J, Stern H, Buhlmeyer K (2009) Responsiveness of raised pulmonary vascular resistance to oxygen assessed by pulsed doppler echocardiography. Br Heart J 66(4):277–280

    Article  Google Scholar 

  41. Zoghbi WA, Enriquez-Sarano M, Foster E et al (2003) Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and doppler echocardiography. J Am Soc Echocardiogr 16(7):777–802

    Article  PubMed  Google Scholar 

  42. Renella P, Aboulhosn J, Lohan DG et al (2010) Two-dimensional and doppler echocardiography reliably predict severe pulmonary regurgitation as quantified by cardiac magnetic resonance. J Am Soc Echocardiogr 23(8):880–886

    Article  PubMed  Google Scholar 

  43. Baumgartner H, Hung J, Bermejo J, Chambers JB, Evangelista A, Griffin BP, Iung B, Otto CM, Pellikka PA, Quinones M (2009) EAE/ASE. Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice. Eur J Echocardiogr 10(1):1–25

    Article  PubMed  Google Scholar 

  44. Vlahos AP, Marx GR, McElhinney D, Oneill S, Goudevenos I, Colan SD (2008) Clinical utility of doppler echocardiography in assessing aortic stenosis severity and predicting need for intervention in children. Pediatr Cardiol 29(3):507–514

    Article  PubMed  Google Scholar 

  45. Silvilairat S, Cabalka AK, Cetta F, Hagler DJ, O’Leary PW (2005) Outpatient echocardiographic assessment of complex pulmonary outflow stenosis: doppler mean gradient is superior to the maximum instantaneous gradient. J Am Soc Echocardiogr 18(11):1143–1148

    Article  PubMed  Google Scholar 

  46. Ikemba CM, Eidem BW, Fraley JK et al (2005) Mitral valve morphology and morbidity/mortality in shone’s complex. Am J Cardiol 95(4):541–543

    Article  PubMed  Google Scholar 

  47. Asante-Korang A, O’Leary PW, Anderson RH (2006) Anatomy and echocardiography of the normal and abnormal mitral valve. Cardiol Young 16(Suppl 3):27–34

    Article  PubMed  Google Scholar 

  48. Platts DG, Sedgwick JF, Burstow DJ, Mullany DV, Fraser JF (2012) The role of echocardiography in the management of patients supported by extracorporeal membrane oxygenation. J Am Soc Echocardiogr 25(2):131–141

    Article  PubMed  Google Scholar 

  49. Thomas TH, Price R, Ramaciotti C, Thompson M, Megison S, Lemler MS (2009) Echocardiography, not chest radiography, for evaluation of cannula placement during pediatric extracorporeal membrane oxygenation. Pediatr Crit Care Med 10(1):56–59

    Article  PubMed  Google Scholar 

  50. Horton SC, Khodaverdian R, Chatelain P et al (2005) Left ventricular assist device malfunction: an approach to diagnosis by echocardiography. J Am Coll Cardiol 45(9):1435–1440

    Article  PubMed  Google Scholar 

  51. Chumnanvej S, Wood MJ, MacGillivray TE, Melo MF (2007) Perioperative echocardiographic examination for ventricular assist device implantation. Anesth Analg 105(3):583–601

    Article  PubMed  Google Scholar 

  52. Durack DT, Lukes AS, Bright DK (1994) New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findings. Duke endocarditis service. Am J Med 96(3):200–209

    Article  CAS  PubMed  Google Scholar 

  53. Habib G, Badano L, Tribouilloy C et al (2010) Recommendations for the practice of echocardiography in infective endocarditis. Eur J Echocardiogr 11(2):202–219

    Article  PubMed  Google Scholar 

  54. Humpl T, McCrindle BW, Smallhorn JF (2003) The relative roles of transthoracic compared with transesophageal echocardiography in children with suspected infective endocarditis. J Am Coll Cardiol 41(11):2068–2071

    Article  PubMed  Google Scholar 

  55. Rosenfeld HM, Gentles TL, Wernovsky G et al (1998) Utility of intraoperative transesophageal echocardiography in the assessment of residual cardiac defects. Pediatr Cardiol 19(4):346–351

    Article  CAS  PubMed  Google Scholar 

  56. Latson LA, Prieto LR (2007) Congenital and acquired pulmonary vein stenosis. Circulation 115(1):103–108

    Article  PubMed  Google Scholar 

  57. Hanna BM, El-Hewala AA, Gruber PJ, Gaynor JW, Spray TL, Seliem MA (2010) Predictive value of intraoperative diagnosis of residual ventricular septal defects by transesophageal echocardiography. Ann Thorac Surg 89(4):1233–1237

    Article  PubMed  Google Scholar 

  58. Bol-Raap G, Weerheim J, Kappetein AP, Witsenburg M, Bogers AJ (2003) Follow-up after surgical closure of congenital ventricular septal defect. Eur J Cardiothorac Surg 24(4):511–515

    Article  CAS  PubMed  Google Scholar 

  59. Dodge-Khatami A, Knirsch W, Tomaske M et al (2007) Spontaneous closure of small residual ventricular septal defects after surgical repair. Ann Thorac Surg 83(3):902–905

    Article  PubMed  Google Scholar 

  60. Yang SG, Novello R, Nicolson S et al (2000) Evaluation of ventricular septal defect repair using intraoperative transesophageal echocardiography: frequency and significance of residual defects in infants and children. Echocardiography 17(7):681–684

    Article  CAS  PubMed  Google Scholar 

  61. Tehrani F, Movahed MR (2007) How to prevent echocardiographic misinterpretation of Gerbode type defect as pulmonary arterial hypertension. Eur J Echocardiogr 8(6):494–497

    Article  PubMed  Google Scholar 

  62. Kelle AM, Young L, Kaushal S, Duffy CE, Anderson RH, Backer CL (2009) The Gerbode defect: the significance of a left ventricular to right atrial shunt. Cardiol Young 19(Suppl 2):96–99

    Article  PubMed  Google Scholar 

  63. Honjo O, Kotani Y, Osaki S et al (2006) Discrepancy between intraoperative transesophageal echocardiography and postoperative transthoracic echocardiography in assessing congenital valve surgery. Ann Thorac Surg 82(6):2240–2246

    Article  PubMed  Google Scholar 

  64. Lee HR, Montenegro LM, Nicolson SC, Gaynor JW, Spray TL, Rychik J (1999) Usefulness of intraoperative transesophageal echocardiography in predicting the degree of mitral regurgitation secondary to atrioventricular defect in children. Am J Cardiol 83(5):750–753

    Article  CAS  PubMed  Google Scholar 

  65. Preminger TJ, Sanders SP, van der Velde ME, Castaneda AR, Lock JE (1994) “Intramural” residual interventricular defects after repair of conotruncal malformations. Circulation 89(1):236–242

    Article  CAS  PubMed  Google Scholar 

  66. Sachdev MS, Bhagyavathy A, Varghese R, Coelho R, Kumar RS (2006) Right ventricular diastolic function after repair of tetralogy of fallot. Pediatr Cardiol 27(2):250–255

    Article  CAS  PubMed  Google Scholar 

  67. Losay J, Touchot A, Capderou A et al (2006) Aortic valve regurgitation after arterial switch operation for transposition of the great arteries: incidence, risk factors, and outcome. J Am Coll Cardiol 47(10):2057–2062

    Article  PubMed  Google Scholar 

  68. Santoro G, Carrozza M, Russo MG, Calabro R (2008) Symptomatic aorto-pulmonary collaterals early after arterial switch operation. Pediatr Cardiol 29(4):838–841

    Article  PubMed  Google Scholar 

  69. Aziz KU, Paul MH, Rowe RD (1977) Bronchopulmonary circulation in d-transposition of the great arteries: possible role in genesis of accelerated pulmonary vascular disease. Am J Cardiol 39(3):432–438

    Article  CAS  PubMed  Google Scholar 

  70. Juraszek AL, Atz AM, Shirali GS (2002) Echocardiographic diagnosis of partial obstruction of blalock-taussig shunts. Cardiol Young 12(2):189–191

    Article  PubMed  Google Scholar 

  71. Cardis BM, Fyfe DA, Ketchum D, Mahle WT (2005) Echocardiographic features and complications of the modified Norwood operation using the right ventricle to pulmonary artery conduit. J Am Soc Echocardiogr 18(6):660–665

    Article  PubMed  Google Scholar 

  72. Lemler MS, Zellers TM, Harris KA, Ramaciotti C (2000) Coarctation index: identification of recurrent coarctation in infants with hypoplastic left heart syndrome after the Norwood procedure. Am J Cardiol 86(6):697–699, A9

    Article  CAS  PubMed  Google Scholar 

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Kirkpatrick, E., Shillingford, A.J., Cohen, M.S. (2014). Echocardiography in the ICU. In: Da Cruz, E., Ivy, D., Jaggers, J. (eds) Pediatric and Congenital Cardiology, Cardiac Surgery and Intensive Care. Springer, London. https://doi.org/10.1007/978-1-4471-4619-3_107

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