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Pediatric Heart (Expert Forum)
mild pulmonary hypertension
Answered by
Jeffrey R Boris, M.D. - Pediatric Cardiology, Ambulatory Cardiology
The Children’s Hospital of Philadelphia
Philadelphia - PA
Questions in this forum are answered by pediatric cardiologists, cardiothoracic surgeons and anesthesiologists from The Children's Hospital of Philadelphia. This forum is for questions and support about pediatric heart problems, symptoms and topics such as heart murmurs, palpitations, fainting, chest pain, congenital heart defects (including management and intervention), fetal cardiology, adult congenital cardiology, arrhythmias and pre-participation athletic screening.
mild pulmonary hypertension
by desiboy, Oct 05, 2009 03:34AM
My son who is 13 years old was asked to do ‘Echo cardiography’ by our family doctor and his report is suggesting “mild pulmonary hypertension”. He is healthy and has no problem before this finding. Please can you explain the below report and advise what we need to do to solve the problem. His further details are as under:
Interpretation:
Normal left ventricular size and function. Trace physiological mitral regurgitation. Trace physiological tricuspid regurgitation. Mild pulmonary hypertension. Subacute bacterial endocarditis prophylaxis is not required.
Cardiac Doppler Images:
The left ventricle was normal in size with overall Grade I systolic function. Normal diastolic filling.
The right ventricle was normal in size and function.
The aortic valve was trileaflet and normal with no regurgitation. The ascending aorta was normal in size.
The mitral valve leaflets were normal. There was trace physiological mitral regurgitation.
The left and right atria were normal.
The pulmonary valve was with no regurgitation.
The tricuspid valve was normal. There was trace physiological tricuspid regurgitation. The right ventricular systolic pressure was estimated at 41 mm/Hg (RA=10) suggesting mild pulmonary hypertension.
There was no pericardial effusion.
Doppler Measurements:
E/A Ratio 1.4
Deceleration Time 145 msec
Isovolumic Relaxation Time 55 msec
Pulmonary Velocity 135 cm/sec
Pulmonary Acceleration Time 134 msec
Cardia Dimensions:
Right Ventricle 17mm
Aorta (base) 26 mm
Left Atrium 20 mm
LV End-Diastole 37 mm
LV End-Systole 27 mm
Septum 7 mm
Posterior Wall 7mm
Interpretation:
Normal left ventricular size and function. Trace physiological mitral regurgitation. Trace physiological tricuspid regurgitation. Mild pulmonary hypertension. Subacute bacterial endocarditis prophylaxis is not required.
Cardiac Doppler Images:
The left ventricle was normal in size with overall Grade I systolic function. Normal diastolic filling.
The right ventricle was normal in size and function.
The aortic valve was trileaflet and normal with no regurgitation. The ascending aorta was normal in size.
The mitral valve leaflets were normal. There was trace physiological mitral regurgitation.
The left and right atria were normal.
The pulmonary valve was with no regurgitation.
The tricuspid valve was normal. There was trace physiological tricuspid regurgitation. The right ventricular systolic pressure was estimated at 41 mm/Hg (RA=10) suggesting mild pulmonary hypertension.
There was no pericardial effusion.
Doppler Measurements:
E/A Ratio 1.4
Deceleration Time 145 msec
Isovolumic Relaxation Time 55 msec
Pulmonary Velocity 135 cm/sec
Pulmonary Acceleration Time 134 msec
Cardia Dimensions:
Right Ventricle 17mm
Aorta (base) 26 mm
Left Atrium 20 mm
LV End-Diastole 37 mm
LV End-Systole 27 mm
Septum 7 mm
Posterior Wall 7mm
Doctor's Answer
by Jeffrey R Boris, M.D., Oct 07, 2009 08:31AM
, Oct 07, 2009 08:31AMTo: desiboy
Dear Desiboy,
I’m not sure why your primary doctor requested the echocardiogram, so it’s difficult to interpret this information in the absence of what is going on with your son. This is why I encourage primary care providers to send their patients with whom they are not comfortable to a cardiologist instead of ordering a test that may find something they don’t know what to do with. It appears that this echocardiogram may have been performed by an adult cardiologist’s office, which is also part of the problem here.
Pulmonary hypertension is high blood pressure across the lungs. It is a rare finding in children, but can happen. There are many reasons for it to occur, which I will not list here. I cannot be sure that your son actually has pulmonary hypertension, though. The way that we noninvasively estimate right-sided pressures is to measure it from the Doppler velocity of the tricuspid valve regurgitation jet. Because the report says that the jet is only “trace,” I cannot be sure that the measurement was not an overestimation of the jet. We now have a finding that may or may not be real and may have nothing to do with the reason that he was referred for the study in the first place. At this time, what I would recommend that you do is to see a pediatric cardiologist and get this evaluated correctly and completely, as opposed to trying to do this through your primary care provider.
I’m not sure why your primary doctor requested the echocardiogram, so it’s difficult to interpret this information in the absence of what is going on with your son. This is why I encourage primary care providers to send their patients with whom they are not comfortable to a cardiologist instead of ordering a test that may find something they don’t know what to do with. It appears that this echocardiogram may have been performed by an adult cardiologist’s office, which is also part of the problem here.
Pulmonary hypertension is high blood pressure across the lungs. It is a rare finding in children, but can happen. There are many reasons for it to occur, which I will not list here. I cannot be sure that your son actually has pulmonary hypertension, though. The way that we noninvasively estimate right-sided pressures is to measure it from the Doppler velocity of the tricuspid valve regurgitation jet. Because the report says that the jet is only “trace,” I cannot be sure that the measurement was not an overestimation of the jet. We now have a finding that may or may not be real and may have nothing to do with the reason that he was referred for the study in the first place. At this time, what I would recommend that you do is to see a pediatric cardiologist and get this evaluated correctly and completely, as opposed to trying to do this through your primary care provider.
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