Pediatric Heart Expert Forum
A few echo questions
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A few echo questions

My daughter, 15 months old, just had a cardiologist appt a few weeks ago to monitor her moderate membranous vsd. I had a few questions spurred from her recent visit.
For her echo it states the LVFS is 50%. What is the normal LVFS for a 15 month old?

We have been told in the past that she has mild physiologic tricuspid valve regurgitation, but that it was not a concern- that it was normal and that 90% of the population has a mild degree of tricuspid valve regurgitation. Do you find the numbers to be that high? Is it ever an issue if it is physiologic and mild? She does have tricuspid valve tissue blocking part of the hole- could that be causing it?

In the past her vsd has been marked as 5-6 mm. On recent report it states it is measuring 2.6 mm from PLAX and 3 mm from apical view. We were told the hole is the same but the tissue became more restrictive. So would these measurements most likely be measuring the amount of space that the tissue is not blocking? Trying to wrap my head around it all. :) Thank you so much and I'm sorry for posting a few questions at once!

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773637_tn?1327450515
Dear Dani,

Echocardiography has given us both a whole new nomenclature as well as a new insight into things of which we were not aware previously in congenital cardiac disease.  The LVFS, or left ventricular fractional shortening, is a two-dimensional measurement of the squeezing/pumping function of the left ventricle, the pumping chamber on the left side.  The normal range for this is 28-44%; however, without looking at your daughter's study, it is difficult to say why she is demonstrating a FS of 50%.  It could be that she was active, or that the ultrasound beam was not lined up correctly, or something else.  However, it is more important to realize that this is just a number and not a picture of the whole patient or the quality of her cardiac function.  Therefore, if she is clinically doing well without getting out of breath or getting sweaty easier than her peers, and she is growing well, this is more important than the actual number of her FS.

Physiologic tricuspid valve regurgitation, or a normal small amount of leak in the tricuspid valve, is something that we did not truly realize existed in as many patients as it does until we got color Doppler with echocardiography.  In fact, all of the valves can leak a little bit.  It is usually trivial, although sometimes it can be as much as mild.  It does bear watching, especially since there is likely what we refer to as aneurysmal tissue from the valve partially obstructing the defect (and, hopefully, eventually closing it).  The orifice that was measured that was previously larger and is now smaller is what is left where blood is traversing the defect.  It sounds as if it is hemodynamically restrictive, which means that it is limiting the amount of blood going through the defect; this is a good thing.  It does not have to completely close, and she may live with this for her life.  It does not typically cause a problem, although it does cause two very slightly increased risks.  One:  it can sometimes cause the aortic valve to deform and leak, so as long as the defect is patent, it should have routine surveillance.  Two:  as long as it is open, there is a slightly increased risk of an infection of the heart, so appropriate dental hygiene is required.
4 Comments
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Avatar_f_tn
Thank you SO much for the response doctor! I appreciate it very, very much.

I'm a bit concerned to know the LVFS was above average though I understand that it does not paint the picture of the cardiac function. Her left ventricle size was marked as the upper limit of normal, so very mildly enlarged. She was crying during much of the echo, would that have affected it? She does not seem to get out of breath or sweaty at all, so hopefully it was just from her being a bit worked up.

And yes, she does have aneurysmal tissue from the tricuspid valve partially closing the hole. They detected it from her very first visit at 2 months old and it appears to be closing it more now. Does a hole that is 5.5 mm really have a chance of closing with that tissue? Seems all I read online says only small ones close. Have you ever seen one like hers close?

Thanks again, I can't tell you how much it means to us parents to have a forum like this to help us!

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Avatar_f_tn
Oh, and I'm so sorry to add on, but I was just thinking- if she was crying during parts of the echo, would that have affected any other readings? Her shunt pressure reading was higher, in the 90's this time compared to in the 60's last time...could it have been higher because she was crying and the heart was pumping harder? I would say she was inconsolable or screaming at all, but she did cry at times.
He said the pressure was higher because it was more restrictive.
I'm just curious because the dr was not in there during the echo, he didn't know she cried a bit.

Thanks again!!
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773637_tn?1327450515
Dear Dani,

Crying absolutely would increase her SF, as it's almost like a stress test or exercise, which increases the heart rate and heart's ability to squeeze.  Therefore, especially in light of the fact that she is otherwise doing well, I would not worry about that specific number.  With regard to the estimated gradient across the shunt, anything above 25 mmHg would be considered "restrictive", so 60 vs. 90 is still restrictive and should be good, assuming a systemic normal blood pressure.

Yes, defefcts of her size do close, although it may take a while.  However, even if it doesn't close, we see plenty of kids who have restrictive defects who do not have any limitations or decrease in the quality or length of their lives.  They just need to be followed routinely by the cardiologist.
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