Top

Published in:

28-02-2022 | Echocardiography | Original Article

Right Ventricular Function in Neonates During Early Postnatal Period: A Prospective Observational Study

Authors: Jerneja Peček, Mirta Koželj, Helena Lenasi, Petja Fister

Published in: Pediatric Cardiology | Issue 6/2022

Abstract

Previous echocardiographic studies were mainly focused on preterm infants and early fetal-to-neonatal transition period, whereas little is known about changes in the parameters of the right ventricular (RV) function after 72 h of life. Our aim was to quantitatively characterize potential changes in RV function by echocardiography in healthy term newborns between the third and the seventh day of life. We conducted a prospective observational study in 35 full-term newborns, in whom we performed echocardiographic examinations on the third and the seventh day of life. We assessed RV function, output and afterload and found a significant increase in all tissue Doppler velocities as well as in RV longitudinal strain, a higher mean RV outflow tract velocity time integral and lower myocardial performance index (MPI'), whereas the tricuspid annular plane systolic excursion, RV filling pattern, and RV outflow tract acceleration time were not significantly different between the third and the seventh day of life. Conclusions: Increased RV systolic and diastolic myocardial velocities, cardiac output and longitudinal deformation and decreased RV MPI' between the third and the seventh day of life point to a reduction of RV afterload and adaptive myocardial maturation in term newborns during this period. Moreover, PW-TDI and 2D speckle-tracking echocardiography seem to be more sensitive for evaluating RV function in comparison with M-mode echocardiography and pulsed-wave Doppler analysis of RV filling.

Agoston-Coldea L, Lupu S (2013) Right chambers quantification in clinical practice: echocardiography compared with cardiac magnetic resonance imaging. In Squeri A (ed) Hot topics in echocardiography. IntechOpen, pp 11–50. https://doi.org/10.5772/55832

Jones N, Burns AT, Prior DL (2019) Echocardiographic assessment of the right ventricle-State of the art. Heart Lung Circ 28(9):1339–1350. https://doi.org/10.1016/j.hlc.2019.04.016CrossRefPubMed

Singh Y, Tissot C (2018) Echocardiographic evaluation of transitional circulation for the neonatologists. Front Pediatr 6:140. https://doi.org/10.3389/fped.2018.00140CrossRefPubMedPubMedCentral

Jain A, Mohamed A, El-Khuffash A, Connelly KA, Dallaire F, Jankov RP, McNamara PJ, Mertens L (2014) A comprehensive echocardiographic protocol for assessing neonatal right ventricular dimensions and function in the transitional period: normative data and Z scores. J Am Soc Echocardiogr 27(12):1293–1304. https://doi.org/10.1016/j.echo.2014.08.018CrossRefPubMed

Ciccone MM, Scicchitano P, Zito A, Gesualdo M, Sassara M, Calderoni G, Di Mauro F, Ladisa G, Di Mauro A, Laforgia N (2011) Different functional cardiac characteristics observed in term/preterm neonates by echocardiography and tissue Doppler imaging. Early Human Dev 87(8):555–558. https://doi.org/10.1016/j.earlhumdev.2011.04.012CrossRef

Eriksen BH, Nestaas E, Hole T, Liestøl K, Støylen A, Fugelseth D (2013) Myocardial function in premature infants: a longitudinal observational study. BMJ Open 3(3):e002441. https://doi.org/10.1136/bmjopen-2012-002441CrossRefPubMedPubMedCentral

Ha KS, Choi BM, Lee EH, Shin J, Cho HJ, Jang GY, Son CS (2018) Chronological echocardiographic changes in healthy term neonates within postnatal 72 hours using Doppler studies. J Korean Med Sci 33(22):e155. https://doi.org/10.3346/jkms.2018.33.e155CrossRefPubMedPubMedCentral

Clark SJ, Yoxall CW, Subhedar NV (2002) Measurement of right ventricular volume in healthy term and preterm neonates. Arch Dis Child Fetal Neonatal Ed 87(2):F89–F93. https://doi.org/10.1136/fn.87.2.f89CrossRefPubMedPubMedCentral

Ghandi Y, Habibi D, Farahani E (2018) Reference values of longitudinal systolic right and left ventricular function measured by M-mode echocardiography in healthy preterm and term neonates. J Cardiovasc Echogr 28(3):177–181. https://doi.org/10.4103/jcecho.jcecho_31_18CrossRefPubMedPubMedCentral

10.

Gill AW (2019) Postnatal cardiovascular adaptation. Arch Dis Child Fetal Neonatal Ed 104(2):F220–F224. https://doi.org/10.1136/archdischild-2017-314453CrossRefPubMed

11.

Mertens L, Seri I, Marek J, Arlettaz R, Barker P, McNamara P, Moon-Grady AJ, Coon PD, Noori S, Simpson J, Lai WW (2011) Targeted neonatal echocardiography in the neonatal intensive care unit: practice guidelines and recommendations for training. Writing group of the American Society of Echocardiography (ASE) in collaboration with the European Association of Echocardiography (EAE) and the Association for European Pediatric Cardiologists (AEPC). J Am Soc Echocardiogr 24(10):1057–1078. https://doi.org/10.1016/j.echo.2011.07.014CrossRefPubMed

12.

Lopez L, Colan SD, Frommelt PC, Ensing GJ, Kendall K, Younoszai AK, Lai WW, Geva T (2010) Recommendations for quantification methods during the performance of a pediatric echocardiogram: a report from the Pediatric Measurements Writing Group of the American Society of Echocardiography Pediatric and Congenital Heart Disease Council. J Am Soc Echocardiogr 23(5):465–495. https://doi.org/10.1016/j.echo.2010.03.019CrossRefPubMed

13.

El-Khuffash A, Schubert U, Levy PT, Nestaas E, de Boode WP (2018) Deformation imaging and rotational mechanics in neonates: a guide to image acquisition, measurement, interpretation, and reference values. Pediatr Res 84(Suppl 1):30–45. https://doi.org/10.1038/s41390-018-0080-2CrossRefPubMedPubMedCentral

14.

Mohammad Nijres B, Bokowski J, Mubayed L, Jafri SH, Davis AT, Abdulla RI (2020) Utility of pulmonary artery acceleration time to estimate systolic pulmonary artery pressure in neonates and young infants. Pediatr Cardiol 41(2):265–271. https://doi.org/10.1007/s00246-019-02251-8CrossRefPubMed

15.

Nestaas E, Schubert U, de Boode WP, El-Khuffash A (2018) Tissue Doppler velocity imaging and event timings in neonates: a guide to image acquisition, measurement, interpretation, and reference values. Pediatr Res 84(Suppl 1):18–29. https://doi.org/10.1038/s41390-018-0079-8CrossRefPubMedPubMedCentral

16.

Kahr PC, Kahr MK, Dabral H, Agarwal R, Kothari SS, Saxena A, Ramakrishnan S (2016) Changes in myocardial contractility and electromechanical interval during the irst month of life in healthy neonates. Pediatr Cardiol 37(2):409–418. https://doi.org/10.1007/s00246-015-1292-4CrossRefPubMed

17.

Mori K, Nakagawa R, Nii M, Edagawa T, Takehara Y, Inoue M, Kuroda Y (2004) Pulsed wave Doppler tissue echocardiography assessment of the long axis function of the right and left ventricles during the early neonatal period. Heart 90(2):175–180. https://doi.org/10.1136/hrt.2002.008110CrossRefPubMedPubMedCentral

18.

Eidem BW, McMahon CJ, Cohen RR, Wu J, Finkelshteyn I, Kovalchin JP, Ayres NA, Bezold LI, O’Brian Smith E (2004) Pignatelli RH (2015) Impact of cardiac growth on Doppler tissue imaging velocities: a study in healthy children. J Am Soc Echocardiogr 17(3):212–221. https://doi.org/10.1016/j.echo.2003.12.005CrossRefPubMed

19.

Kadappu KK, Thomas L (2015) Tissue Doppler imaging in echocardiography: value and limitations. Heart Lung Circ 24(3):224–233. https://doi.org/10.1016/j.hlc.2014.10.003CrossRefPubMed

20.

Abdel-Hady HE, Matter MK, El-Arman MM (2012) Myocardial dysfunction in neonatal sepsis: a tissue Doppler imaging study. Pediatr Crit Care Med 13(3):318–323CrossRef

21.

Nasu Y, Oyama K, Nakano S, Matsumoto A, Soda W, Takahashi S, Chida S (2015) Longitudinal systolic strain of the bilayered ventricular septum during the first 72 hours of life in preterm infants. J Echocardiogr 13(3):90–99. https://doi.org/10.1007/s12574-015-0250-8CrossRefPubMed

22.

Levy PT, El-Khuffash A, Patel MD, Breatnach CR, James AT, Sanchez AA, Abuchabe C, Rogal SR, Holland MR, McNamara PJ, Jain A, Franklin O, Mertens L, Hamvas A, Singh GK (2017) Maturational patterns of systolic ventricular deformation mechanics by two-dimensional cpeckle-tracking echocardiography in preterm infants over the first year of age. J Am Soc Echocardiogr 30(7):685-698.e1. https://doi.org/10.1016/j.echo.2017.03.003CrossRefPubMedPubMedCentral

23.

Erickson CT, Levy PT, Craft M, Li L, Danford DA, Kutty S (2019) Maturational patterns in right ventricular strain mechanics from the fetus to the young infant. Early Hum Dev 129:23–32. https://doi.org/10.1016/j.earlhumdev.2018.12.015CrossRefPubMed

24.

Schwartz PJ, Garson A Jr, Paul T, Stramba-Badiale M, Vetter VL, Wren C, European Society of Cardiology (2002) Guidelines for the interpretation of the neonatal electrocardiogram. A task force of the European Society of Cardiology. Eur Heart J 23(17):1329–1344. https://doi.org/10.1053/euhj.2002.3274CrossRefPubMed

25.

Arce OX, Kundson OA, Ellison MC, Baselga P, Ivy DD, Degroff C, Valdes-Cruz L (2002) Longitudinal motion of the atrioventricular annuli in children: reference values, growth related changes, and effects of right ventricular volume and pressure overload. J Am Soc Echocardiogr 15(9):906–916. https://doi.org/10.1067/mje.2002.121436CrossRefPubMed

26.

Roberson DA, Cui W, Chen Z, Madronero LF, Cuneo BF (2007) Annular and septal Doppler tissue imaging in children: normal z-score tables and effects of age, heart rate, and body surface area. J Am Soc Echocardiogr 20(11):1276–1284. https://doi.org/10.1016/j.echo.2007.02.023CrossRefPubMed

27.

Navaratnam M, Punn R, Ramamoorthy C, Tacy TA (2017) LVOT-VTI is a useful indicator of low ventricular function in young patients. Pediatr Cardiol 38(6):1148–1154. https://doi.org/10.1007/s00246-017-1630-9CrossRefPubMed

28.

Singh Y (2017) Echocardiographic evaluation of hemodynamics in neonates and children. Front Pediatr 5:201. https://doi.org/10.3389/fped.2017.00201CrossRefPubMedPubMedCentral

29.

de Boode WP, Singh Y, Molnar Z, Schubert U, Savoia M, Sehgal A, Levy PT, McNamara PJ, El-Khuffash A (2018) Application of Neonatologist Performed Echocardiography in the assessment and management of persistent pulmonary hypertension of the newborn. Pediatr Res 84(Suppl 1):68–77. https://doi.org/10.1038/s41390-018-0082-0CrossRefPubMedPubMedCentral

30.

Koestenberger M, Avian A, Grangl G, Burmas A, Kurath-Koller S, Hansmann G (2016) Right ventricular outflow tract velocity time integral (RVOT VTI) and tricuspid regurgitation velocity/RVOT VTI ratio in pediatric pulmonary hypertension. Int J Cardiol 212:274–276. https://doi.org/10.1016/j.ijcard.2016.03.111CrossRefPubMed

31.

Gao Y, Raj JU (2010) Regulation of the pulmonary circulation in the fetus and newborn. Physiol Rev 90(4):1291–1335. https://doi.org/10.1152/physrev.00032.2009CrossRefPubMed

32.

Heymann MA, Rudolph AM (1972) Effects of congenital heart disease on fetal and neonatal circulations. Prog Cardiovasc Dis 15(2):115–143. https://doi.org/10.1016/0033-0620(72)90015-1CrossRefPubMed

33.

Haworth, (1988) Pulmonary vascular remodeling in neonatal pulmonary hypertension. State of the art Chest 93(3 Suppl):133S-138S. https://doi.org/10.1378/chest.93.3_Supplement.133SCrossRef

34.

Parasuraman S, Walker S, Loudon BL, Gollop ND, Wilson AM, Lowery C, Frenneaux MP (2016) Assessment of pulmonary artery pressure by echocardiography-A comprehensive review. Int J Cardiol Heart Vasc 12:45–51. https://doi.org/10.1016/j.ijcha.2016.05.011CrossRefPubMedPubMedCentral

Title: Right Ventricular Function in Neonates During Early Postnatal Period: A Prospective Observational Study
Authors: Jerneja Peček
Mirta Koželj
Helena Lenasi
Petja Fister
Publication date: 28-02-2022
Publisher: Springer US
Keywords: Echocardiography
Echocardiography
Published in: Pediatric Cardiology / Issue 6/2022
Print ISSN: 0172-0643
Electronic ISSN: 1432-1971
DOI: https://doi.org/10.1007/s00246-022-02855-7

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

At a glance: The STEP trials

Springer Medicine

Right Ventricular Function in Neonates During Early Postnatal Period: A Prospective Observational Study

Abstract

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

At a glance: The STEP trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 6/2022

Hemodynamic Assessment of a Large Pulmonary Arteriovenous Malformation in a Neonate: Case Report and Review of Literature

Native Aortic Root Thrombosis in Single-Ventricle Patients with Native-to-Neoaortic Anastomoses

Longitudinal Observational Study of Cardiac Outcome Risk Factor Prediction in Children, Adolescents, and Adults with Barth Syndrome

Platelet Activation Markers in Children with Pulmonary Arterial Hypertension Associated with Congenital Heart Disease

CMR Imaging After Myocarditis Associated with mRNA COVID-19 Vaccine: Correspondence

Multiple Giant Coronary Artery Aneurysms in a Pediatric Patient with Granulomatosis with Polyangiitis

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page