The pulmonic valve echogram in the assessment of pulmonary hypertension in children

Echocardiographic patterns of pulmonary valve motion and right-sided systolic time intervals were correlated with pulmonary arterial hemodynamics in 56 children with congenital heart defects. The sensitivity of an abnormal a-dip, reduced e-f slope or mid-systolic valve closure in detecting elevated pulmonary artery diastolic or mean pressures or pulmonary to systemic resistance ratio varied from 36 to 62%. Specificities ranged from 50% (e-f slope for increased Rp:Rs) to 93% (mid-systolic closure for PA diastolic pressure greater than 10 mm Hg). Systolic-time-intervals (RPEP/RVET) did not significantly correlate with pulmonary hemodynamics. We therefore conclude that these echocardiographic features are insufficiently sensitive to be clinically applied to detect pulmonary hypertension in pediatric patients, and that only 2 (a-dip and mid-systolic closure) were of sufficient specificity to be useful.