Application Of Echocardiography In Diagnosis And Evaluation Of Congenital Heart Disease With Left-to-right Shunt And Pulmonary Hypertension

Part 1 Classification of congenital heart disease with pulmonary hypertension by echocardiographyObjective By studying the cardiac structure and dynamics of congenital heart disease (CHD) combined with pulmonary hypertension (PH) using echocardiography, compared with right cardiac catheter, to explore the standard of classification of PH by echocardiography. Method A total of 60 patients with CHD-ventricular septal defect (VSD) and/or patent ductus arteriosus (PDA) with different levels of PH were included in this study. A group of parameters including the diameters of left ventricle and right ventricle from anterior to posterior (LVD, RVD), left to right (LVT, RVT), ratio of LVT/RVT, the thickness of right ventricular anterior wall (RVAW), the shunt flow velocity (FLV) were measured by echocardiography. The examination of right cardiac catheter on all of the patients was completed within three days post echo exam. The PH was classified into three levels according to the total pulmonary resistance (TPR) measured by cardiac catheter, and each level included 20 patients. The standard of classification for PH by echocardiography could be concluded through analyzing the cardiac structures and characteristics of homodynamic of different levels of PH. Result PH of Level I featured in dynamic PH, of which the left ventricular diameter was obviously enlarged, while the right ventricular diameter kept in normal range. The RVAWD was not thick and the shunt was left to right with high velocity. Level II gradually exhibited the feature of resistant PH. The enlarged LV withdrew to slight dilatation or even to normal diameter. The RV became enlarged as much as the ratio of RVT/LVT reached to 2/3~ 1 and the RVAW was thickened. The shunt FLV decreased to low velocity and the right-to- left shunt appeared in some patients. In cases of level III, the TPR was extremely increased. The diameter of LV diminished, whereas the RV was enlarged as much as RVT>LVT. The RVAW continued to incrassate and apparent right to left shunt appeared. Of all the parameters,...