Pediatric Cardiology

, Volume 36, Issue 6, pp 1129–1134 | Cite as

Right Ventricular Outflow Tract Velocity Time Integral Determination in 570 Healthy Children and in 52 Pediatric Atrial Septal Defect Patients

  • Martin KoestenbergerEmail author
  • Bert Nage
  • William Ravekes
  • Alexander Avian
  • Ante Burmas
  • Gernot Grangl
  • Gerhard Cvirn
  • Andreas Gamillscheg
Original Article


Determination of the right ventricular outflow tract velocity time integral (RVOT VTI) is an important part of the noninvasive investigation of pulmonary blood flow in adults; however, age-related pediatric reference data are lacking. We examined growth-related changes of RVOT VTI values in children and the predictive value of RVOT VTI values in identifying enhanced pulmonary blood flow in children with secundum type atrial septal defect (ASD). A prospective study was conducted in a group of 570 healthy children and 52 children with a moderate-sized to large ASD. We determined the effects of age, body length (BL), body weight (BW), and body surface area (BSA) on RVOT VTI values. The predictive value of normal values stratified for age, BW, BL, and BSA was tested in our 52 ASD children. RVOT VTI values ranged from mean 9.7 ± 1.2 cm in neonates to 23.3 ± 2.7 cm in children with 18 years of age and showed a positive correlation with age, BL, BSA, and BW. In our population, RVOT VTI z-scores showed a high specificity for detecting ASD patients (>97 %) with sensitivity up to 71 %. We provide normal ranges and calculated z-scores of pediatric RVOT VTI values. Normal RVOT VTI z-scores might be additional predictors in identifying increased pulmonary blood flow in patients with ASD.


Atrial septal defect Pediatric Pulmonary blood flow Right ventricular outflow tract Velocity time integral Z-Scores 


Conflict of interest

All authors state that there are no financial, personal or other relationships with other people or organizations that could inappropriately influence our work to disclose.


  1. 1.
    Abbas AE, Fortuin FD, Schiller NB, Appleton CP, Moreno CA, Lester SJ (2003) A simple method for noninvasive estimation of pulmonary vascular resistance. J Am Coll Cardiol 41:1021–1027PubMedCrossRefGoogle Scholar
  2. 2.
    Abbas AE, Franey LM, Marwick T, Maeder MT, Kaye DM, Vlahos AP et al (2013) Noninvasive assessment of pulmonary vascular resistance by Doppler echocardiography. J Am Soc Echocardiogr 26:1170–1177PubMedCrossRefGoogle Scholar
  3. 3.
    Ajami GH, Cheriki S, Amoozgar H, Borzouee M, Soltani M (2011) Accuracy of Doppler-derived estimation of pulmonary vascular resistance in congenital heart disease: an index of operability. Pediatr Cardiol 32:1168–1174PubMedCrossRefGoogle Scholar
  4. 4.
    Arkles JS, Opotowsky AR, Ojeda J, Rogers F, Liu T, Prassana V et al (2011) Shape of the Right Ventricular Doppler Envelope Predicts Hemodynamics and Right Heart Function in Pulmonary Hypertension. Am J Respir Crit Care Med 183:268–276PubMedCrossRefGoogle Scholar
  5. 5.
    Bhatt DD, Manoj R, Mahajan R (2012) Estimation of pulmonary vascular resistance: correlation between echocardiography and catheterization data in patients with congenital heart disease. Echocardiography 29:478–483PubMedCrossRefGoogle Scholar
  6. 6.
    De Koning WB, van Osch-Gevers LM, Robbers-Visser D, van Domburg RT, Bogers AJ, Helbing WA (2013) Enlarged right ventricular size at 11 years’ follow-up after closure of secundum-type atrial septal defect in children. Cardiol Young 23:7–13PubMedCrossRefGoogle Scholar
  7. 7.
    Farzaneh-Far R, Na B, Whooley MA, Schiller NB (2008) Usefulness of noninvasive estimate of pulmonary vascular resistance to predict mortality, heart failure, and adverse cardiovascular events in patients with stable coronary artery disease (from the Heart and Soul Study). Am J Cardiol 101:762–766PubMedCentralPubMedCrossRefGoogle Scholar
  8. 8.
    Kulik TJ (2012) Pulmonary blood flow and pulmonary hypertension: Is the pulmonary circulation flowophobic or flowophilic? Pulm Circ 2:327–339PubMedCentralPubMedCrossRefGoogle Scholar
  9. 9.
    Lam YY, Fang F, Yip GW, Li ZA, Yang Y, Yu CM (2012) New pulmonary vein Doppler echocardiographic index predicts significant interatrial shunting in secundum atrial septal defect. Int J Cardiol 160:59–65PubMedCrossRefGoogle Scholar
  10. 10.
    Masuyama T, Kodama K, Kitabatake A, Sato H, Nanto S, Inoue M (1986) Continuous-wave Doppler echocardiographic detection of pulmonary regurgitation and its application to noninvasive estimation of pulmonary artery pressure. Circulation 74:484–492PubMedCrossRefGoogle Scholar
  11. 11.
    McMahon CJ, Feltes TF, Fraley JK, Bricker JT, Grifka RG, Tortoriello TA et al (2002) Natural history of growth of secundum atrial septal defects and implications for transcatheter closure. Heart 87:256–259PubMedCentralPubMedCrossRefGoogle Scholar
  12. 12.
    Nakahata Y, Hiraishi S, Oowada N, Ando H, Kimura S, Furukawa S 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 30:232–239PubMedCrossRefGoogle Scholar
  13. 13.
    Oh JK, Seward J, Tajik A (1994) The echo manual. Little, Brown and Company, Boston, pp 51–58Google Scholar
  14. 14.
    Pees C, Glagau E, Hauser J, Michel-Behnke I (2013) Reference values of aortic flow velocity integral in 1193 healthy infants, children, and adolescents to quickly estimate cardiac stroke volume. Pediatr Cardiol 34:1194–1200PubMedCrossRefGoogle Scholar
  15. 15.
    Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K et al (2010) Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr 23:685–713PubMedCrossRefGoogle Scholar
  16. 16.
    Tonelli AR, Conci D, Tamarappoo BK (2014) Prognostic Value of Echocardiographic Changes in Patients with Pulmonary Arterial Hypertension Receiving Parenteral Prostacyclin Therapy. J Am Soc Echocardiogr 27:733–741PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Martin Koestenberger
    • 1
    Email author
  • Bert Nage
    • 1
  • William Ravekes
    • 2
  • Alexander Avian
    • 3
  • Ante Burmas
    • 1
  • Gernot Grangl
    • 1
  • Gerhard Cvirn
    • 4
  • Andreas Gamillscheg
    • 1
  1. 1.Division of Pediatric Cardiology, Department of PediatricsMedical University GrazGrazAustria
  2. 2.Division of Pediatric CardiologyJohns Hopkins University School of MedicineBaltimoreUSA
  3. 3.Institute for Medical Informatics, Statistics and DocumentationMedical University GrazGrazAustria
  4. 4.Centre of Physiological Medicine, Institute of Physiological ChemistryMedical University GrazGrazAustria

Personalised recommendations