Heart and Vessels

, Volume 34, Issue 2, pp 296–306 | Cite as

Development of suction force during early diastole from the left atrium to the left ventricle in infants, children, and adolescents

  • Ken TakahashiEmail author
  • Masaki Nii
  • Kiyohiro Takigiku
  • Manatomo Toyono
  • Satoru Iwashima
  • Nao Inoue
  • Noboru Tanaka
  • Kotoko Matsui
  • Sachie Shigemitsu
  • Mariko Yamada
  • Maki Kobayashi
  • Kana Yazaki
  • Keiichi Itatani
  • Toshiaki Shimizu
Original Article


Although the suction force that moves blood into the left ventricle during early diastole is thought to play an important role in diastolic function, there have been a few studies of this phenomenon in normal children. Suction force is measured as the intraventricular pressure difference (IVPD) and intraventricular pressure gradient (IVPG), which is calculated as IVPD divided by left ventricular length. The purpose of this study was to determine the suction force in infants, children, and adolescents using IVPD and IVPG. We included 120 normal children categorized into five groups based on age: G1 (0–2 years), G2 (3–5 years), G3 (6–8 years), G4 (9–11 years), and G5 (12–16 years). The total, basal, and mid–apical IVPD and IVPG were calculated using color M-mode Doppler imaging of the mitral valve inflow using the Euler equation. The total IVPD increased with age from G1 to G5 (1.75 + 0.51 vs. 2.95 + 0.72 mmHg, respectively; p < 0.001), due to an increase in mid–apical IVPD with constant basal IVPD. Although total IVPG was constant, mid–apical IVPG was larger in G5 than in G1 (0.21 + 0.06 vs. 0.16 + 0.07 mmHg/cm, respectively; p = 0.006). Total, basal, and mid–apical IVPDs were significantly correlated with age and the parameters of heart size and mitral annular eʹ. Mid–apical IVPG correlated with age and e′ positively, but basal IVPG did with age negatively and did not with e′. The suction force increased at the mid–apical segment, correlating with increasing heart size and developing left ventricular relaxation, even after adjustment for left ventricular length.


Diastolic function Intraventricular pressure difference Intraventricular pressure gradient Echocardiography 



We thank the members of the Japanese Pediatric Echocardiographic Research Team and the staff of Shizuoka Children’s Hospital for collecting the echocardiographic data of children without cardiac defects.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from the parents or legal guardians of all individual participants included in the study.

Supplementary material

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Supplementary material 1 (GIF 93 kb)
380_2018_1239_MOESM2_ESM.gif (93 kb)
Supplementary material 2 (GIF 93 kb)


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Copyright information

© Springer Japan KK, part of Springer Nature 2018

Authors and Affiliations

  • Ken Takahashi
    • 1
    Email author
  • Masaki Nii
    • 2
  • Kiyohiro Takigiku
    • 3
  • Manatomo Toyono
    • 4
  • Satoru Iwashima
    • 5
  • Nao Inoue
    • 6
  • Noboru Tanaka
    • 1
  • Kotoko Matsui
    • 1
  • Sachie Shigemitsu
    • 1
  • Mariko Yamada
    • 1
  • Maki Kobayashi
    • 1
  • Kana Yazaki
    • 1
  • Keiichi Itatani
    • 7
  • Toshiaki Shimizu
    • 1
  1. 1.Department of PediatricsJuntendo University Faculty of MedicineTokyoJapan
  2. 2.Department of CardiologyShizuoka Children’s HospitalShizuokaJapan
  3. 3.Department of Pediatric CardiologyNagano Children’s HospitalNaganoJapan
  4. 4.Department of Pediatrics, Graduate School of Medicine, Organ Function-Oriented MedicineAkita UniversityAkitaJapan
  5. 5.Department of PediatricsChutoen General Medical CenteShizuokaJapan
  6. 6.Department of PediatricsSeirei Hamamatsu General HospitalShizuokaJapan
  7. 7.Department of Cardiovascular Surgery, Cardiovascular Imaging Research LaboratoryKyoto Prefectural University of MedicineKyotoJapan

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