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Challenges in Echocardiographic Assessment of Mitral Regurgitation in Children After Repair of Atrioventricular Septal Defect

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Abstract

The validity and reproducibility of echocardiographic methods used to quantify mitral regurgitation (MR) in children with congenital heart disease are unknown. We evaluated the usefulness of methods used to quantify MR in children enrolled in a multicenter trial of enalapril 6 months after surgical repair of an atrioventricular septal defect (AVSD). MR severity in this trial was assessed using body surface area (BSA)-adjusted vena contracta lateral (i-VCWlat) and anterior-posterior (i-VCWap) dimensions and cross-sectional area (i-VCA), regurgitant volume/BSA, regurgitant fraction, and qualitative MR grade. For each method, association with left ventricular end-diastolic volume (LVEDVz) and end-diastolic dimension (LVEDDz) z-scores and interobserver agreement were assessed. In 149 children (median age 1 year), i-VCWlat, i-VCWap, and i-VCA were best associated with LVEDVz (r 2 = 0.54, r 2 = 0.24, and r 2 = 0.46, respectively; p < 0.001 for all) and showed the highest interobserver agreement (intraclass correlation coefficient = 0.62, 0.73, and 0.68, respectively). Qualitative MR grade was also associated with LVEDVz (r 2 = 0.31, p < 0.001) and showed modest interobserver agreement (kappa 0.56). Regurgitant volume/BSA and regurgitant fraction were associated with LVEDVz (r 2 = 0.45 and r 2 = 0.45, p < 0.001 for both) but showed poor interobserver agreement [ICC = 0.28 (n = 91) and ICC = 0.17 (n = 76), respectively], and their values were negative in 75% of subjects. In conclusion, echocardiographic assessment of MR severity after AVSD remains challenging. Among the quantitative methods used in this trial, i-VCW and i-VCA performed the best but offered little advantage compared with qualitative MR grade. The utility of regurgitant volume and fraction was severely limited by poor interobserver agreement and frequently negative values.

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Acknowledgment

This work was supported by U01 grants from the National Heart, Lung, and Blood Institute (Grants no. HL068269, HL068270, HL068279, HL068281, HL068285, HL068292, HL068290, and HL068288).

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Authors and Affiliations

  1. Department of Cardiology, Children’s Hospital Boston, 300 Longwood Avenue, Boston, MA, 02115, USA

    Ashwin Prakash, Ronald V. Lacro, Steven D. Colan & Jami C. Levine

  2. Columbia University College of Physicians and Surgeons, New York, NY, USA

    Ashwin Prakash

  3. New England Research Institutes, Watertown, MA, USA

    Lynn A. Sleeper & Steven D. Colan

  4. University of Utah, Salt Lake City, UT, USA

    L. LuAnn Minich

  5. The Hospital for Sick Children, Toronto, ON, Canada

    Brian McCrindle & Fraser Golding

  6. Wake Forest University Health Sciences, Winston Salem, NC, USA

    Wesley Covitz

  7. Medical University of South Carolina, Charleston, SC, USA

    Anthony M. Hlavacek

  8. Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Meryl S. Cohen

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  1. Ashwin Prakash
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  2. Ronald V. Lacro
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  3. Lynn A. Sleeper
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  4. L. LuAnn Minich
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  7. Wesley Covitz
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  8. Fraser Golding
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  9. Anthony M. Hlavacek
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  10. Jami C. Levine
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  11. Meryl S. Cohen
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Correspondence to Ashwin Prakash.

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This study is conducted for the Pediatric Heart Network Investigators.

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Prakash, A., Lacro, R.V., Sleeper, L.A. et al. Challenges in Echocardiographic Assessment of Mitral Regurgitation in Children After Repair of Atrioventricular Septal Defect. Pediatr Cardiol 33, 205–214 (2012). https://doi.org/10.1007/s00246-011-0107-5

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  • DOI: https://doi.org/10.1007/s00246-011-0107-5

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